HX64121925 
RC341  .As3  The  problem  of  nervo 


"  NERVOUS  BREAKDO 

EDWIN  ASH,  M.  D, 

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THE  PROBLEM  OF  NERVOUS 
BREAKDOWN 


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THE  PROBLEM    OF 
NERVOUS  BREAKDOWN 


BY 

EDWIN   LANCELOT  ASH 

DOCTOR    OF   MEDICINE 


NEW  YORK 
THE    MACMILLAN   COMPANY 

1920 


Copyright  in  the  British  Empire  by  Mills  &  Boon,  Ltd. 


FOREWORD 

rriHE  concern  alike  of  doctors,  nurses,  social  workers, 
-L  care  committees,  schoolmasters,  military  authori- 
ties, prison  ofl&cials,  and  others  who  have  frequently 
before  them  questions  which  can  only  be  efficiently 
answered  in  the  light  of  some  understanding  of  its  vari- 
ous bearings  the  problem  of  nervous  breakdown  is  to-day 
of  great  importance.  Hence,  anyone  who  has  had  special 
opportunities  of  studying  the  mind  and  nervous  system 
in  health  and  in  disorder  may  weU  feel  desirous  of  placing 
his  experiences  and  conclusions  before  the  widest  possible 
circle  just  now.  The  kind  reception  of  my  earlier  work, 
Nerves  and  the  Nervous — out  of  print  for  some  time  since 
— has  encouraged  me  to  write  this  book,  the  purpose  of 
which  is  to  review  the  problem  as  it  affects  the  individual 
and  as  it  concerns  the  State  ;  to  discuss  the  origin  of  the 
more  common  disorders,  and  to  indicate  in  what  direc- 
tions it  is  possible  for  us  to  redress  the  balance  in  favour 
of  nerve  and  efficiency.  Throughout  I  have  particularly 
borne  in  mind  the  difficulties  of  the  family  doctor,  the 
trained  nurse,  and  the  anxious  relative  upon  whose 
shoulders  faUs  the  grave  responsibility  of  bringing  back 
those  stricken  in  "  nerve  "  to  useful  life  and  work. 

THE   AUTHOR. 
London,  W., 

January,  1919. 


CONTENTS 


PART  I 
THE  ORIGINS  OF  NERVOUS  BREAKDOWN 

CHAPTER  I 

THE   PROBLEM   STATED 

A_  nation's  worth  is  based  on  individual  nerve — The  new  age — ■ 
Efficiency  the  hey  to  success — Nerve  health  the  key  to  effici- 
ency— Nervous  breakdown  a  question  of  national  importance 
— Stress  and  stram  of  modern  life — Fo'an.dations  of  nervous 
breakdown — Inherent  hardiness  of  human  nerves — Indica- 
tions of  failing  nerve — The  problem  to  be  solved — Importance 
of  mental  control — Economic  aspect  of  nervous  breakdown     page     3 

CHAPTER  II 

THE    EMOTIONS 

Hiunan  feelings — Emotional  stress  and  nervoiis  breakdown — 
Definition  of  emotion — Feeling  and  action — Physical  accom- 
paniments of  emotional  excitement — Anger — Grief — Fear — 
Our  feelmgs  stamped  on  our  bodies — -Higher  emotions — 
Heart  versus  head — Intellectuahzing  one's  feelings — Personal 
reactions  of  emotions — Ways  in  which  emotional  stress  causes 
nervous  disorder — Illustrations  .  .  .  ,  .  .17 

CHAPTER  III 

NERVOUS    TEMPERAMENT 

Nervousness — Temiperament  and  character — Reaction  to  en- 
vironment— Types  of  temperament — The  nervous  tempera- 
ment— Temperamental  blends — Normal  and  abnormal  nerv- 
ousness— Eccentricity — National  temperaments — Degeneracy 
— Genius  and  morbidity — The  ex-Kaiser  as  an  interesting 
study  in  temperament         .  .  .  .  .  .  .38 


viii     THE  PROBLEM  OF  NERVOUS  BREAKDOWN 
kchapter  IV 

SOME   FACTORS    DETERMINING    BREAKDOWN 

Stresses  of  daily  life — Work  and  worry — Common  anxieties — 
Household  worries — The  worrjdng  habit — Nerve  weakness 
and  a  burdened  mind — Nerves  and  domesticities — Strain  of 
development     ........      fage     51 

CHAPTER  V 

CONDITIONS   PREDISPOSING   TO   BREAKDOWN 

[A)  Occupation,  Climate  and  Constitution 

Predisposing  as  opposed  to  determining  causes — The  prevalence 
of  breakdown  among  brain  workers — Influence  of  occupation 
— Strain  of  modern  conditions — Motoring — Telephone  work 
— Occupational  breakdown  in  America — Climate  and  nemras- 
thenia — Debilitated  effects  of  residence  in  Tropical  countries 
— Heredity — Ancestral  indiscretions — ^larriage  and  consan- 
guinity— Depleted  stocks   .......        60 

CHAPTER  VI 

CONDITIONS    PREDISPOSING   TO    BREAKDO\VN 

[B)  Poisons,  Shocks  and  Some  Others 

Nerve  poisons — Autointoxication — Tea,  coffee,  alcohol  and 
tobacco — Drug  taking — Influenza — Trench  fever — Accidents 
and  injiu-ies — Traixmatic  neurasthenia — Nervous  breakdown 
after  operations — Race — Age       .  .  .  .  .  .71 


PART  II 
THE  VARIETIES  OF  NERVOUS  BREAKDOWN 

CHAPTER  I 

FORMS  OF  NERVOUS  BREAKDOWN 

Harmony  of  functions  necessary  for  health — Basis  of  control — 
Central  nervous  system — The  brain  the  seat  of  government — 
Ramification  of  nerve  fibres — The  term  "  nerves  " — Nerves 
in  disorder — The  nervous  tj^e — Classification  of  nervous 
diseases — Relations  of  nervous  breakdown — Three  chief 
groups — Neurasthenia — Hysteria — The  so-called  borderland 
— Terms  in  common  use — Psycho-neurosis — Psychasthenia     . 


CONTENTS  ix 

CHAPTER  II 

THE   NEtTRASTHENIC   STATE  ' 

Neurasthenia — L'homme  a  petits  papiers — Common  neuras- 
thenic symptoms — The  question  of  subgroups — Le  casquet 
neurasthenique — Other  head  troubles — ^Weakening  of  self- 
control — Fear  of  losing  reason — Stevenson's  picture  of  col- 
lapse from  over-work — General  consequences  of  neurasthenia 
— Heart  and  circulation — Over-sensitiveness — Some  typical 
examples.  ..,,,...      fage     89 


CHAPTER  III 

MORBID    FEARS   AND    DOUBTS 

Obsessions  —  Psychasthenia — Obsessional  neurasthenia — Web- 
ster's definition  of  "  obsession  " — Common  forms  of  obses- 
sional thoughts — Morbid  fears — Their  physical  accompani- 
ments — Agoraphobia  —  Claustrophobia  —  Siderophobia  — An- 
thopophobia — Morbid  flushing  and  self-consciousness — Patho- 
phobia— Astrophobia — Batophobia — Fears  about  health — 
Morbid  anxieties — Doubts  and  scruples — Over-conscientious- 
ness— Fear  of  impulsive  action — Some  examples  .  .  .     107 


CHAPTER  IV 

NERVOUS   nSTDIGESTION 

Dyspepsia  a  common  accompaniment  of  nervous  disorder — Tone 
and  its  failtire — Digestive  processes  susceptible  to  mental 
influences — Definitions  of  nervous  indigestion — Consequences 
of  dyspepsia — Vicious  circle — Characteristics  of  nervous  dys- 
pepsia— Auto-intoxication — Secondary  consequences — Classi- 
fication of  cases — Mucous  colitis — Common  misconceptions — 
Treatment  must  be  mental  as  well  as  physical.       •  .  .     124 


CHAPTER  V 

HYSTERIA 

A  psychological  riddle — Hysteria  known  to  the  ancients — 
Pithiatism  —  Sydenham's  definition  —  Bygone  theories  — 
Common  signs  of  hysteria — Basis  of  the  hysterical  state — 3  ' 
Disorders  of  movement — Curious  reactions — Disorders  of 
sensation — Witch's  marks — Disturbances  of  general  health — 
Hysterical  attacks — La  grande  hysterie — Illustrations    .  .138 


X       THE  PROBLEM  OF  NERVOUS  BREAKDOWN 
CHAPTER  VI 

MXTLTIPIiB  PERSONALITY 

A  simple  case — Morbid  desire  for  notoriety — Dual  personality — 
An  interesting  problem — Consequences — Alternating  person- 
ality— The  case  of  Felida  X — -A  clergyman's  experience — 
Loss  of  Memory — The  famous  Sally  Beauchamp — Dr.  Morton 
Prince's  analysis — Professor  Janet's  investigations — Simula- 
tion of  demoniacal  possession — Dangers  of  dissociation .      page  153 

CSAPTER  VII 

WHAT   THEN   IS    HYSTERIA  ? 

The  hysterical  temperament  —  Its  characteristics — Deficient 
powers  of  attention — Morbid  emotionalism — Abnormal  sug- 
gestibility— The  spoiled  child — Unliealthy  dreaminess — Vain 
imaginings — What  is  hysteria  ? — Discarded  views — No 
physical  basis  found — Eabinski's  theory — Auto-suggestion — 
Charcot — Janet's  hj'phothesis — The  Freudian  School — Other 
theories   ..........      162 


PAUT  III 
THE  HYGIENE  OF  NERVE 

CHAPTER  I 

REDRESSING    THE    BAIANCE 

Prevention  of  nervous  breakdown — A  special  problem  of  hygiene 
— Not  a  question  of  destroying  germs — ^Modern  requirements 
for  treatment — Difficulties  of  family  practitioner — So-called 
nerve  tonics — Principles  of  physical  treatment — Electrical 
methods — Massage — The  sick  soul — Morbid  introspection — 
Suggestion  of  right  ideas — Other  methods  of  treatment 
through  mind — Fuiactional  and  organic  diseases — The  search 
for  a  reliable  principle  of  mind  treatment — Prayer .  .  .173 

CHAPTER  II 

THE   REST   CTTRE 

{A)  General  Principles 

Natiiral  recuperative  forces — The  great  vis  medicatrix  naturae — 
Medieval  and  modern  medicine  contrasted — The  principle  of 
rest — Weir  Mitchell's  rest  cure — Modern  modifications — 
Planning  a  rest  ciu-e — Attitude  of  invaUd — Dta-ation — Place 
of  treatment — Home  or  institution — Nursing — Qualifications 
of  the  ner^e  nurse — General  sui foundings      -  .  .  .188 


CONTENTS  xi 

CHAPTER  IIIj 

THE   BEST   CtTRE 

{B)  Routine 

Daily     Routine — Sleep — Nourisliment — Massage — Occupation — 

A  typical  programme  .  .  ~      .  .  .  .      page  201 

CHAPTER  IV 

DIET  AND    SOME  OTHER  POINTS  IN   CONVALESCENCE 

Nerve  energy  dependent  on  nutrition — Diet  in  nervous  maladies 
— Personal  idiosyncrases— Advantages  and  disadvantages  of 
milk — A  mixed  diet — General  principles  of  diet — Sugar — 
Cheese — Stimulants — Baths — Effects  on  nervous  system — 
"  Reaction  " — ^Important  rules — Clothing — Natural  heat — 
Exercise  and  body  temperature  .....      209 

CHAPTER  V 

SLEEP   AND    SLEEPLESSNESS 

The  mystery  of  sleep — Effects  on  brain — An  interesting  experi- 
ment— Ability  to  sleep  at  will — Insomnia — Common  forms — 
Causes — Fear  and  insomnia — Simple  sleep-bringing  devices — 
The  restful  mind — Some  maxims         .  .  .  .  .220 

CHAPTER  VI 

REST   AND   RECBEATION 

Rest  apart  from  sleep — The  rest  hour — Ways  of  securing  rest — 
Husbanding  resources — Unhealthy  restlessness — The  proper 
ordering  of  spare  time — Over-exercise — Common-sense  and 
nerve  energy — Rest  and  over- work — Recreation — Walking — 
Cycling — Golfing — Change  of  air — Sea  voyages — Smoking      .     230 

CHAPTER  VII 

CHILDHOOD    AND    YOUTH 

Child  father  to  the  man — Plasticity  of  early  Ufe — The  nervous 
temperament  in  childhood — Childhood  fears — Night  terrors — 
Enuresis  nocturna — Hygiene  of  children's  nerves — Diet  in 
childhood — Mental  hygiene  in  the  nursery — Morbid  sensitive- 
ness— Powers  for  work  and  play — Dangers  of  over-strain — A 
reasonable  programme — Sensitiveness  of  early  life^ Youth — 
Critical  period  of  adolescence — Its  characteristics  and 
dangers — The  psychology  of  young  men  and  maids         .  .     240 


xii      THE  PROBLEM  OF  NERVOUS  BREAKDOWN 
CHAPTER  VIII 

PBINCIPLES    OF   SBLF-HEUP 

The  will  to  be  well — Misconceptions  about  self-help — Importance 
of  co-operation  between  patient  and  doctor — Conscientious- 
ness in  carrying  out  instructions — Holding  on  during  set-backs 
— Self-reverence,  self-knowledge,  self-control — Strengthening 
self-control  —  Exercising  inhibitory  power  —  Self-denial  — 
Getting  rid  of  f etir — Nerve-health  and  religious  faith       .      page  268 


PART  IV 
THE  BREAKDOWNS  OF  WAR 

CHAPTER  I 

THE   EFFECTS    OF   WAR   STRAIN 

Strain  of  modern  warfare — Shock  from  explosion — The  strain  of 
battle — Brain  liable  to  both  mental  and  physical  assaults — 
Determining  facts  of  war-strain  and  civilians — General  worries 
— Raids  and  bombardment         ......     269 

CHAPTER  II 

SHBLL-SHOCK 

The  wounded  in  mind — No  new  disease — A  convenient  term — 
Battle-field  breakdown — Characteristics  of  war-neurasthenia 
— Typical  examples — Mental  shock  and  its  consequences — 
Paralysis — Other  limitations  of  movement — Astasia-abasia — 
Dumbness — Blindness  —  Deafness  —  Further  illustrations  — 
Mental  breakdown — War-hj-steria — Psj'^chological  basis  of 
shell-shock — The  outlook  in  war-breakdowns        .  .  .277 


Indbs  .         .         .         ,         .  .  .         •         •         .     291 


PART  I 
THE    ORIGINS    OF  NERVOUS  BREAKDOWN 


THE  PROBLEM  OF 
NERVOUS  BREAKDOWN 

CHAPTER  I 

THE  PROBLEM   STATED 

A  nation's  worth  is  based  on  individual  nerve — The  new  age — Effi- 
ciency the  key  to  success — Nerve  health  the  key  to  efficiency — 
Nervoiis  breakdowii  a  question  of  national  importance — Stress 
and  strain  of  modern  life — Foundations  of  nervous  breakdown — 
Inherent  hardiness  of  human  nerves — ^Indications  of  failing  nerve 
— The  problem  to  be  solved — Importance  of  mental  control — 
Economic  aspect  of  nervous  breakdown. 

AS  a  field  of  wheat  is  made  up  of  separate  ears,  as  tlie 
Jl\-  strength  of  a  chain  rests  in  its  links,  as  the  majesty 
of  a  forest  resides  in  the  trees  forming  it,  as  the  beauty 
of  a  garden  embraces  the  fairness  of  its  flowers — so 
does  the  efficiency  of  a  nation  depend  on  the  worth  of  its 
individual  sons  and  daughters.  And  the  value  of  the 
individual  is  in  the  ultimate  a  question  of  nerve.  Our 
merit  as  children  of  empire  is  a  matter  of  nerve  to  per- 
severe, to  lift  up  OUT  hearts,  to  endure  through  all  that 
fortune  brings  ;  and  to  enjoy  sanely  the  great  rewards 
our  efforts  gain.  Health,  nerve  and  efficiency — ^these 
constitute  the  grand  triumvirate  of  human  power,  in- 
separable in  their  mutual  influences,  failing  together 
when  one  fails,  unconquerable  when  together  each 
strengthens  the  other.  And  so  it  is  that  any  prevalent 
set  of  circumstances  that  threatens  one  of  these  three 
pillars  of  our  individual  well-being  threatens  the  security 
of  the  commonwealth  and  presents  a  problem  for  very 

3 


4   THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

serious  consideration.  To-day  the  ubiquitous  occurrence 
of  nervous  breakdown  constitutes  just  such  a  problem. 

We  stand  on  the  threshold  of  a  new  age  in  which  man- 
kind may  well  achieve  greater  triumphs  than  any  known 
in  the  past  ;  we  are  at  the  beginning  of  an  era  when, 
inspired  by  the  spirit  of  liberty,  the  race  may  take  a  long 
step  forward.  In  this  great  age  that  is  before  us  each 
individual  will  be  weighed  according  to  the  worth  of  that 
which  he  can  do  for  his  fellows,  and  his  patriotism  will 
be  expressed  not  only  by  his  sense  of  duty  towards  his 
native  country,  but  by  the  value  of  his  contribution  to 
the  welfare  of  the  Greater  State  of  the  World.  Thus  there 
never  was  a  time  when  the  capacity  for  work  possessed  by 
each  of  us  had  greater  worth  and  greater  potentialities 
for  good,  or  when  the  call  for  efficiency  in  our  daily  lives 
was  more  urgent. 

For  the  development  of  aviation  alone  it  is  of  the  utmost 
national  importance  that  a  high-level  of  nerve  be  main- 
tained. The  Prime  Minister  has  warned  us  that  we  cannot 
maintain  a  splendid  State  with  inferior  national  health  ; 
it  is  quite  certain  that  British  youth  can  only  make  its 
grand  inheritance  in  the  air  if  its  health  and  nerve  be 
assured.  Every  one  is  agreed  that  the  future  possibili- 
ties of  flying  in  the  times  of  peace  before  us  are  immeasur- 
able ;  let  us  make  certain -then  that  no  slackness  prevents 
us  helping  every  young  man  who  wishes  and  who  has 
any  reasonable  chance  of  becoming  a  good  aviator  from 
overcoming  natural  disabilities  of  nerve  that  at  first 
hamper  him.  From  the  wider  outlook  let  us  remember 
that  an  improved  state  of  nerve -health  in  the  coming 
generations  means  in  the  matter  of  flying  alone  an 
incalculable  national  asset. 

There  is  no  need  to  labour  the  point  that  any  dis- 
cord in  the  workings  of  the  nervous  system — which  is 
the  centre  of  control — is  at  once  reflected  in  lowered 
efficiency,  as  well  as  impaired  health.  From  which  it 
follows  that  every  one  should  know  how  to  care  for  his 


THE  PROBLEM  STATED  5 

nervous  system  and  to  promote  his  nerve  ;  that  every 
one  should  have  some  knowledge  of  the  chief  rules  for 
keeping  mind,  brain  and  nervous  system  in  proper  and 
harmonious  action  and  reaction.  Nerve  health  is  the 
key  to  efficiency,  and  efficiency  is  the  key  to  success.  No 
man  whose  nerve  ceUs  are  tked  or  poisoned,  or  strained, 
or  impaired  in  any  way,  can  attain  a  full  measure  of 
working  efficiency,  and,  therefore,  no  one  thus  disabled 
can  do  his  or  her  best  for  family,  self,  country,  or  humanity. 
On  the  other  hand,  the  stronger  the  nerve  the  higher  the 
level  of  efficiency- — the  easier  the  road  to  success  and  the 
better  the  opportunities  for  doing  one's  duty  as  a  think- 
ing, working,  human  being.  The  world  has  recently 
suffered  so  much  strain,  sorrow  and  anxiety  that  it  is  not 
to  be  wondered  at  if  there  is  a  tendency  for  general  nerve 
health  to  be  rather  below  par.  Consequently  the  author 
hopes  that  the  observations  he  has  to  make  will  serve 
as  useful  sign-posts  both  to  those  who  have  the  care 
of  invahds  and  to  some  who  have  felt  then  nerves 
waver  a  Httle  and  their  strength  flag— sign-posts  point- 
ing to  the  twm-goals  of  health  and  efficiency.  The 
problem  we  have  to  solve  is  how  best  we  can  minimise 
the  common  drags  and  hindrances  to  the  satisfactory 
workings  of  the  nervous  system,  how  life  should  be  lived 
to  get  the  best  results  by  those  who  are  unfortunately 
handicapped  with  some  nervous  clehcacy,  and  how  those 
should  be  encouraged  who  have  been  cast  down  by  some 
shock  or  blow  of  outrageous  fortune,  and  who  are  now 
striving  to  struggle  back  to  then'  old  level  of  strength. 
Certainly  in  considering  this  problem  we  shall  be  very 
careful  to  remember  the  victims  of  nervous  troubles 
brought  about  through  their  services  to  their  country  in 
time  of  war. 

So  increasingly  evident  that  akeady  in  the  decades 
immediately  preceding  the  Great  War  writers  caUed 
attention  to  them  as  the  "  disease  of  the  age,"  nervous 
disorders  have  now  with  war-time's  impetus  assumed  a 


6   THE  PROBLEM  OP  NERVOUS  BREAKDOWN 

prominent  place  in  questions  of  national  health  and 
economics.  In  some  ways  they  are  the  penalty  exacted  of 
civilized  mankind  for  the  daring  advances  of  the  past  fifty 
or  sixty  years  ;  claiming  victims  on  all  sides  and  among 
the  followers  of  a  thousand  callings.  In  the  study,  the 
office  and  council  chamber  men  have  fallen  under  the 
nerve-strain  caused  by  the  rush  and  emotional  tension  of 
modern  life.  Women  formerly  withdrawn  from  the  major 
stresses  of  the  world  have  come  out  from  their  sheltered 
paths  to  share  in  the  rough  and  tumble  of  the  fight  in  the 
open  fields.  India,  Africa  and  other  tropical  countries 
also  have  contributed  their  quota  of  neurasthenics  drawn 
from  those  unable  to  withstand  the  enervating  influences 
of  the  tropics.  The  pace  grows  and  the  brain  reels  under 
the  stimulation  of  rapid  transit,  quick  communication, 
and  competitive  stress.  Only  the  fit  can  survive  the 
turmoil. 

Constitutional  make-up,  inherited  strength  or  weak- 
ness, temperament,  occupation,  cu'cumstances  and 
friends  all  influence  the  individual's  reaction  to  the  strains 
and  stresses  of  life  ;  hkewise  they  are  deciding  factors 
in  the  all-important  question  as  to  whether  he  will  suffer 
breakdown  or  not.  At  the  outset  it  stands  out  clearly 
that  a  man's  nervous  system  may  collapse  from  causes 
inherent  in  it  or  from  stress  brought  to  bear  from  with- 
out. He  may  suffer  neurasthenia  because  his  brain  cells 
are  delicate  through  inherited  transmission  of  weakness, 
or  his  nerves  may  fail  through  exhaustion  or  the  shock  of 
an  explosion.  Often  enough  the  failure  depends  on  some 
comparatively  moderate  stress  from  without  proving  too 
much  for  a  system  that  has  been  strong  enough  to  bear 
life's  ordinary  burdens  but  no  stronger.  In  any  case,  the 
nervous  organisation  is,  of  all  systems,  particularly  un- 
favourably situated  in  that  it  has  to  bear  the  brunt  of 
stresses  coming  from  two  directions.  Not  only  is  it  liable 
to  exhaustion,  poisoning  or  damage  from  physical  causes, 
but  it  is  continually  swept  by  emotional  waves  that  set 


THE  PROBLEM  STATED  7 

it  vibrating.  That  emotion  may  be  as  tiring  as  running 
a  race,  that  playing  chess  may  take  as  much  out  of  the 
body  as  mowing  a  lawn,  are  things  proved.  Consequently 
the  problem  of  nervous  breakdown  repeatedly  confronts 
us  with  the  interaction  of  two  Idnds  of  influence,  physical 
and  mental,  the  sensitive  nervous  system  being  the  scape- 
goat of  both. 

Not  a  few  writers  have  endeavoured  to  solve  the  prob- 
lem by  referring  everything  back  to  disturbances  of  the 
well-being  of  nerve-cells  and  nerve-fibres,  making  the 
question  entirely  one  of  physical  state.  Brain,  spinal 
cord,  nerve-cells  and  nerve-fibres  we  know,  they  have 
cried  ;  we  can  see  them,  dissect  them  out  and  subject 
them  to  microscopic  examination.  Mind  we  know  not. 
We  grant  that  it  is  an  all-important  function  of  human 
life,  because  unless  a  man  thinks  and  is  conscious  he  has 
no  proper  existence.  But  we  have  decided  that  mind  is 
secondary  to  brain-action  ;  it  must  be  a  sort  of  electrical 
current  generated  by  batteries  of  brain-cells  ;  a  briUiant 
flame  that  waxes  and  wanes  Avith  the  physical  health  of 
the  nervous  system.  We  have,  in  fact,  come  to  the  con- 
clusion that  mind  cannot  primarily  interfere  with  or 
influence  bodily  functions  and  reactions.  Mental  trouble 
spells  physical  disorder  somewhere.  If  it  cannot  be  found 
blame  our  methods  of  investigation  rather  than  our 
theory  ! 

And  so  one  has  said  that  nervous  breakdown  is  always 
due  to  poisoning  from  the  bowel,  another  that  poisoning 
from  the  teeth  is  its  origin  ;  others  say  that  it  is  a  case  of 
simple  physical  fatigue  of  nerve-centresremediable  by  rest ; 
yet  others  find  the  cause  in  errors  of  hygiene,  weakened 
circulation,  faults  of  diet  and  what  not  else  besides.  That 
the  physical  state  of  the  brain  does  influence  mental  out- 
look is  sure  enough  ;  every  drunkard  show^s  this  clearly. 
But  against  that  one  has  to  put  the  results  of  modern 
investigations  proving  how  emotional  trouble  alone  will 
precipitate  a  breakdown,  and  demonstrating  how  treat- 


8   THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

ment  through  mind  alone  will  not  infrequently  serve  to 
clear  up  a  host  of  neurasthenic  troubles  largely  expressed 
by  physical  disturbances.  Indeed,  however  much  physi- 
cal causes  may  contribute  to  a  nervous  breakdown,  or 
however  much  physical  disorders  may  figure  in  the 
results,  the  deciding  factor  is  very  often  psychological. 
Were  nervous  breakdown  merely  a  material  result  of  a 
depleted  nervous  system,  and  its  remedy  just  the  strength- 
ening of  exhausted  elements,  the  problem  would  be  more 
simple  ;  it  is  the  complicated  mind  reactions  occurring 
simultaneously  with  the  organic  troubles  that  make  its 
solution  difficult. 

As  a  matter  of  fact,  delicate  in  structure  as  they  are, 
nervous-tissues  are  remarkably  hardy,  and  possess  re- 
markable powers  of  recuperation.  It  is  an  astonishing 
thing  that  after  prolonged  strain  such  as  is  often  ex- 
perienced in  warfare  men  will  frequently  recover  their 
nerve  and  mental  power  after  one  long  sleep.  One  is  not 
now  referring  to  instances  of  "  shock,"  but  to  those  of 
extreme  fatigue  where  temporary  mental  disability, 
evidenced  by  impaired  memory,  depression  and 
"  vacancy,"  as  well  as  other  signs,  has  indicated  great 
fatigue  of  nerve-elements.  Again,  where  for  experi- 
mental reasons  persons  have  been  kept  awake  for  a  long 
period  it  has  been  found  that  quite  a  small  extra  allow- 
ance of  sleep  subsequently  at  once  restored  their  mental 
vigour.  Again,  consider  the  impunity  with  which  nar- 
cotic and  sedative  drugs  are  administered  daily  with  the 
direct  object  of  medicinally  "  poisoning  "  the  brain- 
ceUs,  Patients  recover  from  chloroform,  "  gas,"  ether  or 
morphia  without  harm  ;  and  it  is  a  rare  and  noteworthy 
occurrence  should  any  sign  of  brain-cell  damage  appear 
after  such  administrations,  which  are  made  in  millions 
every  year.  This  applies  not  only  to  constitutionally 
strong  people,  but  to  those  in  whom  the  nervous  system 
admittedly  shares  in  or  exhibits  inherent  delicacy. 
Regarded  as  a  physical  problem,  the  marvel  would  be 


THE  PROBLEM  STATED  9 

not  that  some  persons  break  down  under  modern  stresses 
— ^particularly  those  of  recent  years — but  that  any  avoid 
collapse.  Looked  at  as  a  mental  problem  we  see  that 
mind  has  qualities  that  enable  it — when  properly  ex- 
pressed— to  maintain  serenity  even  amidst  the  most 
appalling  conditions,  and  not  only  to  do  this,  but  actually 
to  protect  over-sensitive  brain-cells  from  the  disastrous 
consequences  of  emotional  disturbance.  In  a  word,  it 
takes  a  good  deal  to  brea.k  down  the  average  nervous 
system,  and  even  those  possessed  of  constitutionally 
delicate  brains  have  inherent  means  of  protection  and 
a  greater  capacity  for  lessening  stress  than  is  generally 
understood. 

Even  delicate  nervous  systems  rarely  collapse  at  the 
first  storm.  Usually  several  tempests  rage  through  the 
sensitive  brain  before  it  wilts  and  breaks.  True  enough, 
a  "  nervous  attack  "  often  appears  to  be  of  sudden  onset, 
but  the  close  observer  notes  that  heralds  of  a  coming 
storm  had  been  pointing  to  danger  for  those  wise  enough 
to  understand.  So  often  friends  seem  careless  and  rela- 
tives not  a  little  unsympathetic,  and  the  burden  of 
increasing  fatigue  is  borne  until  some  possibly  trifling 
incident  becomes  the  last  straw  to  break  the  back  of 
nervous  fibre.  Many  breakdowns  might  be  prevented 
did  friends  show  more  common  sense,  more  charity  and 
more  consideration.  One  wonders  how  it  is  that  this  can 
be.  Is  it  that  the  medical  profession  have  discouraged 
people  from  taking  "  nerves  "  at  aU  seriously  ?  Is  it  that 
the  healthy  man  or  woman  is  naturally  unsympathetic 
towards  those  abnormally  sensitive  ?  Or  is  it  that  as  a 
characteristic  of  his  state  the  individual  so  carefully 
hides  all  signs  of  the  nervous  tension  within  him  that 
every  one  is  deceived  into  thinking  him  secure  ?  It  ought 
to  be  open  and  easy  for  every  nervous  person  to  know 
where  to  seek  sympathetic  and  experienced  advice,  so 
that  whenever  he  feels  that  loss  of  control  which  so  often 
presages  the  impending  brain-storm,  he  can  obtain  help 


10  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

and  be  protected  from  harm  until  the  stress  of  mind  and 
nerves  has  been  relieved.  It  stands  to  reason  that  on  any 
delicately  balanced  nervous  system  continual  worry  or 
harassing  circumstances  must  exert  a  steadily  increasing 
effect  of  tension  ;  that  eventually  this  tension  must  reach 
a  point  which  to  the  nervous  is  breaking-point  ;  and  that 
a  crisis  which  would  be  safely  passed  through  by  an 
individual  with  a  healthy  brain  is  likely  to  disturb  others 
very  seriously. 

When  this  storm  takes  the  form  of  depression,  the 
patient  suffers  all  the  terrible  agonies  of  the  melancholic, 
and  tends  to  get  deeper  and  deeper  into  the  slough  of 
despond.  Sometimes  a  passing  storm  has  remote  con- 
sequences of  a  kind  which  may  be  conveniently  illus- 
trated by  such  an  example  as  the  following  :  A  business 
man  of  moderate  means  finds  himself  persistently  em- 
barrassed by  an  unlucky  chain  of  circumstances,  and 
suffers  crisis  after  crisis,  each  being  accompanied  by  a 
small  nerve-storm  that  is  not  big  enough  to  ruffle  the 
outward  surface  of  his  calm,  collected  demeanour. 
Apparently  he  stands  firm  and  safely  passes  through 
this  troublesome  time  ;  apparently  his  embarrassments 
have  ceased  before  his  nerve-strength  had  become  ex- 
hausted. Some  time  later  a  trifling  iUness — a  chill,  mild 
influenza,  or  an  attack  of  rheumatism — occurs,  and 
breakdown  quickly  follows.  The  stress  which  he  had  been 
able  to  bear  up  against  successfully  is  now  unbearable, 
and  the  overwrought  brain  is  unable  to  withstand  longer 
the  blows  of  adverse  fortune.  Instances  occur  in  which 
the  collapse  is  not  evidenced  by  severe  exhaustion  or 
other  definite  sign  so  that  its  true  significance  may  well 
be  overlooked.  It  may  be  expressed  in  irrational  actions 
which  do  not  attract  any  particular  attention.  On  close 
investigation  these  may  be  found  extravagant,  wanting 
in  balance,  but  no  close  observer  is  there  to  make  a 
report.  This  hitherto  quiet  man  may  embark  on  some 
wild  scheme  of  finance,  or  expansion,  and  precipitate 


THE  PROBLEM  STATED  11 

himself  into  sudden  ruin.  Or,  on  the  other  hand,  he  may 
actually  succeed  vnth  his  plans  and  find  himself  in  un- 
dreamed-of prosperity.  In  either  case,  neither  he  nor  his 
friends  will  understand  how  their  changed  circumstances 
are  due  to  nervous  instabihty — in  short  to  a  brain-storm. 
It  m&,y  be  said  there  is  no  point  in  its  being  recognized. 
But  there  is,  because  for  one  success  there  are  many 
failures,  and  no  prosperity  is  worth  the  price  of  a  damaged 
brain. 

In  the  individual  sudden  waves  of  brain-disturbance 
frequently  cause  a  good  deal  of  misery  by  giving  rise  to 
impulsive  thoughts.  In  certain  circumstances  sudden 
impulses  arise  in  the  mind  of  even  the  healthiest  people. 
Thus  there  are  many,  without  experience  of  nervousness, 
under  the  ordinary  conditions  of  life,  who,  if  they  find 
themselves  at  the  edge  of  a  high  chff,  or  on  the  roof  of  a 
high  house,  or  walking  along  an  elevated  bridge,  feel  an 
impulse  to  throw  themselves  over.  This  is  not  at  all 
uncommon,  and  one  sees  the  same  kind  of  thing  in  an 
exaggerated  and  more  distressing  form  in  instances  in 
which  the  impulse  takes  the  thought  of  precipitation 
underneath  a  train  or  other  vehicle.  It  should  be  some 
comfort  to  those  who  are  bothered  with  such  impulses 
to  know  that  of  aU  the  thousands  of  individuals  who  are 
afflicted  in  this  way  but  a  very  small  proportion  ever 
yield  thereto.  The  great  thing  is  to  lend  such  aid  and 
sympathy  to  persons  bothered  with  impulses  as  to  prevent 
them  getting  worse.  Unfortunately,  impulsive  thoughts 
sometimes  tend  to  suggest  others  of  the  same  kind,  and 
unless  counteracted  by  strong  suggestion  from  without 
they  may  go  on  and  render  the  patient's  fife  increasingly 
miserable.  Only  those  who  have  experienced  the  torture 
of  these  things  can  appreciate  what  it  is  always  to  be 
subject  to  the  sudden  promptings  of  an  impish  thought, 
that  suggests  that  they  shall  do  harm  to  then  friends  or 
relatives,  never  to  be  able  to  free  oneseK  permanently 
from  these  promptings,  and  in  consequence  never  to  be 


12  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

absolutely  sure  of  what  one  really  will  do.  It  is  my  ex- 
perience that  when  such  a  person  understands  that  he  or 
she  does  not  stand  alone,  but  is  a  member  of  a  fairly 
large  group  of  other  unfortunate  sufferers  tortured  in  a 
similar  way,  a  certain  amount  of  rehef  comes  from  a  true 
appreciation  of  this  position.  Nervous  children  are 
particularly  subject  to  brain-storms  which  are  repre- 
sented by  the  terrible  rages  some  Httle  people,  v.ho  are 
natm'ally  over-strung,  get  into  on  occasions  ;  and  if  one 
follows  the  lives  of  such  nervous  children,  it  will  be  found 
that  in  many  cases  when  they  grow  up  into  adult  hie 
then'  brain-storms  persist  although  in  somewhat  different 
forms. 

In  addition  to  these  things,  the  problem  under  con- 
sideration demands  of  us  that  we  should  make  some 
further  attempt  to  understand  those  prevalent  nervous 
maladies  which  caU  for  repeated  periods  of  rest,  and  are 
admittedly  beyond  the  reach  of  drugs.  Those  who  enjoy 
good  health  are  hard  put  to  it  to  understand  the  con- 
dition of  anyone  who  in  spite  of  keenness  and  ambition 
is  constantly  weighed  doT\ai  by  this  feehng  of  slackness. 
Such  tnedness  hamiting  its  victim  from  morning  till 
night,  restricting  work  and  preventing  enjoyment,  is  one 
of  the  conditions  that  have  most  commonly  to  be  dealt 
with  in  nervous  breakdoAra.  Then,  again,  we  want  to 
know  more  about  the  mental  depression  which  for  no 
apparent  reason  attacks  neurasthenic  persons.  We  want 
to  know  why  sense  of  fatigue  and  depression  so  often  go 
hand  in  hand,  and  why  it  is  that  in  their  tm^n  they  lead  to 
other  morbid  signs  and  to  the  building  up  of  a  huge  pile 
of  crippling  nerve  symptoms.  Our  inquiry  must  have  a 
Wide  range.  The  peculiarities  of  the  neurasthenic  head- 
ache— typically  giving  sensation  of  a  heavy  weight 
pressing  on  the  top  of  the  head,  or  of  a  band  tied  tightly 
round  the  temjDles,  or  of  a  vice  gripping  the  forehead — 
require  investigation  ;  so  also  do  the  innumerable  sensa- 
tions that  occur  with  broken  nerve — sharp  pains,  prick- 


THE  PROBLEM  STATED  13 

ings,  numbness,  and  neuralgia.  Why  should  a  busy  man 
carry  with  him  through  life  a  sense  of  weight  upon  his 
head  which  rarely  lifts,  suffering  it  for  perhaps  twenty  or 
thirty  years,  and  then  finding  one  day  that  for  very  little 
apparent  cause  it  suddenly  lifts  and  frees  him  from  his 
burden  ?  Racing  thoughts,  cm'ious  buzzings  and  other 
noises  in  the  head,  distressing  attacks  of  sudden  giddi- 
ness, want  of  self-confidence,  morbid  flushings  of  the 
face,  and  obsessing  thoughts,  aU  have  to  be  considered. 
In  no  other  class  of  illness  have  such  elusive  and  mysteri- 
ous disturbances  to  be  examined.  What  strange  and 
partly  hidden  chain  of  thought,  or  what  disturbance  of 
the  normal  thought  stream,  leads  to  such  terrors  as 
claustrophobia,  or  agoraphobia  ?  To  say  that  a  person  is 
claustrophobic  is  to  give  a  high  sounding  name  to  an 
incomprehensible  state  of  mind,  but  does  not  explain 
why  he  should  be  reduced  to  a  trembling  and  uncon- 
trolled condition  just  because  he  finds  himself  in  a  locked 
room,  a  lift,  a  tube  railway,  or  other  confined  space. 
Neither  does  the  term  agoraphobia  in  any  way  help  us 
to  understand  why  a  similar  state  of  nervous  collapse 
overcomes  some  individuals  when  they  have  to  cross  a 
field,  square,  or  other  open  space. 

The  list  of  anxieties,  fears,  and  doubts  thus  suffered 
can  never  be  completed,  because  they  are  as  infinite  in 
variety  as  the  patients  whose  nerves  are  disordered,  and 
those  who  have  to  help  them  are  always  adding  to  their 
notes  fresh  descriptions  of  various  mental  tortures  which 
no  other  class  of  individuals  is  ever  caUed  upon  to  suffer. 
One  has  known  a  man  of  strong  physique  and  sturdy 
intellect  who  has  been  like  a  terrified  child  when  he  found 
himself  in  a  wide,  empty  street,  or  even  in  a  large,  empty 
room  ;  and  others  who  would  never  be  suspected  of  nerve- 
weakness  by  their  friends  who  suffer  the  acutest  mental 
agony  if  they  have  to  travel  in  an  underground  tube 
railway,  or  are  confined  for  a  few  minutes  in  a  lift  which 
refuses  to  act.    There  are  capable  brain-workers  who  are 


14   THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

tormented  all  day  about  some  such  absurd  thing  as 
whether  they  have  touched  a  certain  lamp-post  on  walking 
to  and  from  their  destination  ;  or  as  to  whether  they 
have  looked  up  a  particular  street  on  passing  it. 

It  is,  of  course,  clear  that  many  manifestations  of  acute 
or  chronic  nervous  breakdown  depend  upon  loss  of  mental 
control ;  not  only  the  unreasonable  fears,  shyness,  con- 
fusion, and  sense  of  unworthiness,  morbid  blushing, 
obsessing  thoughts  and  alike  which  bother  nervous 
people,  but  many  of  the  digestive  and  other  physical 
disturbances  are  based  on  this  failure  of  control.  More- 
over, associated  with  this  particular  want  of  mental 
power  is  a  morbid  predominance  of  fear.  Not  only  is 
there  slackness  in  the  power  of  thought  direction,  but 
there  is  a  usurpation  of  the  mental  field  by  sense  of  terror, 
and  it  is  characteristic  of  the  fear  that  it  is  beyond  reach 
of  reason.  Certainly  it  may  be  said  that  in  some  ways 
serious  and  obsessing  nervous  fears  are  not  unlike  the 
common  dislike  of  certain  colours,  horror  of  various 
creeping  animals,  dread  of  darkness,  shown  by  many 
people  in  ordinary  health.  Indeed,  one  can  learn  some- 
thing about  nervous  "  phobias  "  by  paying  a  little  atten- 
tion to  these  very  common  fears.  Thus,  taking  the 
not  unusual  dread  of  thunderstorms,  the  individual  of 
sound  nerve  knows  by  experience  that  under  ordinary 
circumstances  the  thunderstorm  will  not  harm  him  in  any 
way,  and  in  spite  of  disliking  the  experience,  pulls  himself 
together  and  bothers  no  more  about  it  ;  but  the  nervous 
individual,  although  knowing  that  the  thunderstorm  is 
harmless,  is  unable  to  control  the  fear  it  inspires. 

The  nervous  subject  is  often  fully  aware  that  many 
of  his  complaints  are  unreasonable,  but  that  makes  him 
suffer  all  the  more.  For  the  time  being  he  cannot  help 
them,  though  they  are  unreasonable.  He  is  unable  to 
inhibit  the  fear — failure  of  capacity  to  inhibit.  He  has 
lost  in  part  or  wholly  the  power  of  inhibition  that  has  won^ 
for  Man  his  pre-eminent  position  in  the  animal  kingdom. 


THE  PROBLEM  STATED  15 

Nervous  people  do  not  fear  cats  or  mice  because  they 
reasonably  consider  that  such  animals  may  harm  them. 
Certainly  not.  Their  expressions  of  alarm  are  due  to 
wild,  unreasoning  terrors  which  fly  up  in  their  minds  at 
the  sight  of  these  creatures  ;  terrors  which  they  are 
unable  to  crush  down  if  their  power  of  inhibition  is  at  all 
weak.  Take,  for  example,  the  indecision  that  torments 
many  neurasthenic  persons,  and  causes  many  a  victim  of 
shattered  nerves  to  explain,  "  I  cannot  make  up  my  mind 
to  do  anything  "  ;  or  to  utter  the  bitter  complaint, 
thoughts  being  out  of  control — ^that  the  "  brain  won't 
work." 

The  average  person  probably  never  realizes  the  cease- 
less loss  which  is  incurred  to  the  nation  by  the  premature 
breakdown  of  men  who  would  unquestionably  do  lasting 
work  of  the  greatest  public  importance  as  lawyers,  social 
reformers,  preachers,  journahsts,  physicians  or  surgeons, 
were  they  able  to  recover  their  lost  health.  Every  year 
men  of  these  classes  may  be  seen  to  give  up  their  work 
without  hope  of  ever  taking  it  up  again  in  the  same  way, 
and  the  national  loss  from  these  cases  of  nervous  break- 
down is  incalculable.  We  talk  much  about  increasing 
and  preserving  the  physical  strength  of  the  nation,  but 
we  do  nothing  to  preserve  or  strengthen  its  nerve -force. 
Perhaps  one  day  the  State  will  see  the  wisdom  of  founding 
sanatoria  for  such  people,  where  the  brilliant  scientist 
shall  be  able  to  recuperate  his  lost  nerve-strength  mth- 
out  undue  anxiety,  and  be  made  fit  to  continue  his  studies 
to  the  advantage  of  the  race  as  a  whole  ;  where  the  rising 
barrister,  who  has  exhausted  himself  in  the  pursuit  of 
legal  wisdom,  shall  be  able  likewise  to  regain  his  strength 
and  once  more  devote  himself  to  the  career  which  will,  in 
its  own  way,  be  of  public  advantage  ;  where  the  writer 
who  has  a  great  message  to  dehver  shall  be  able  to  get 
back  his  impaired  vitality,  and  resume  the  lofty  task  laid 
upon  him. 

It  would,  of  course,  be  absurd  to  place  all  brain-workers 


16  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

in  the  category  of  the  unfit ;  but  the  fact  remains 
that  such  a  large  proportion  of  them  at  the  present  time 
are  hampered  by  the  results  of  nervous  instability  that 
it  is  becoming  a  matter  of  real  importance  to  consider 
some  such  provision  for  them  as  that  referred  to. 
One  cannot  suggest  that  any  overworked  professional 
man  should  be  able  to  gain  free  rest  and  treatment  in  a 
sanatorium  just  whenever  he  likes,  but  it  should  be  possible 
for  any  worker  whose  work  can  be  shown  to  be  of  real 
benefit  to  the  public  at  large  to  obtain,  when  his  condition 
demanded  it,  such  rest  and  attention  at  the  expense  of 
the  State. 


CHAPTER  II 

THE   EMOTIONS 

Human  feelings — Emotional  stress  and  nervous  breakdown — Definition 
of  emotion — Feeling  and  action — Physical  accompaniments  of 
emotional  excitement — -Anger  — Grief — Fear — Our  feelings  stamped 
on  our  bodies — Higher  emotions — Heart  versus  head — Intellectual- 
izing  one's  feelings— Personal  reactions  to  emotions — Ways  in  wliich 
emotional  stress  causes  nervous  disorder- — Illustrations. 

IT  is  part  of  our  daily  experience — as  every  one  who 
takes  the  trouble  to  study  his  thought-processes  will 
quickly  observe — that  the  rnental  states  that  occasion, 
or  are  invariably  accompanied  by,  disturbances  of  our 
sense  of  well-being  are  those  which  are  concerned  with 
our  feehngs.  It  is  not  so  much  what  we  think  as  what  we 
feel  about  things  that  disturbs  the  steady  beat  of  our 
hearts,  or  hurries  our  breathing  ;  although,  of  course, 
our  feeling  is  really  about  what  we  think  of  things.  The 
very  fact  that  our  feehngs  so  obviously  move  us  has  led 
to  the  more  scientific  term  given  to  them  in  psychology  ; 
our  feehngs  are,  indeed,  our  emotions,  the  word  emotion 
being  quite  a  transparent  modern  representation  of  the 
Latin  emovere  :  to  move  out,  to  shako  up.  And  the  one 
thing  that  stands  out  clearly  when  one  studies  the  causa- 
tion of  nervous  breakdown  in  its  full  development,  as 
exemphfied  by  those  invalids  who  are  so  ill  that  they 
consult  a  specialist,  is  the  prominence  of  the  emotive 
factor.  '  Undoubtedly,  a  number  of  familiar  conditions 
operating  in  the  sphere  of  physical  well-being  often 
predispose  or  appear  directly  to  cause  nervous  break- 
-down — these,  including  exhausting  diseases,  accidents, 
and  nerve -poisons,  will  be  discussed  later  under  special 
0  17 


18  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

headings — but  even  when  this  is  so  it  is  more  often  than 
not  that  a  strong  psychological  factor  is  found  to  be 
operating  at  the  same  time. 

As  a  matter  of  practical  experience  one  usually  finds 
causes  both  mental  and  physical  in  any  particular  case, 
and  it  is  difficult  to  disentangle  the  separate  causative 
ailments,  but  an  entkely  wrong  conception  of  nervous 
conditions  will  be  obtained  by  those  who  over-estimate 
the  influence  of  either  cause.  Usually  distm-bing 
mind-states — ^that  is  emotional  stresses — are  the  deter- 
mining factors  in  the  final  breakdown  of  the  nervous 
machinery.  So  much  has  this  impressed  some  authorita- 
tive investigators  that  more  than  one  theory  of  purely 
psychological  causation  has  been  put  forward  by  eminent 
writers.  Thus,  those  distinguished  French  observers, 
Professor  Dejerme  and  Dr.  Gauckler,  hold  that  neuras- 
thenia is  entirely  psychological  in  origin,  although  they 
do  not  extend  this  observation  to  those  types  of  nervous 
breakdown  which  exhibit  psychasthenic  symptoms  such 
as  obsessions,  or  those  allied  to  so-called  mental  diseases. 
They  "  hold  that  neurasthenia  is  due  whoUy  to  psycho- 
logical factors,  and  these  psychological  factors  are  essenti- 
ally, if  not  exclusively,  determined  by  emotion."  ^  More- 
over, they  go  so  far  as  to  say  that  physical  fatigue  or 
overstrain  by  itself  never  occasions  neurasthenia,  a  state- 
ment which  appears  to  be  at  variance  with  daily  experi- 
ence, although  it  is  quite  true  that  nervous  breakdown 
due  to  over-work  unaccompanied  by  such  mental  stress 
as  worry  or  grief  is  comparatively  uncommon.  "  Over- 
work and  fatigue  are  no  more  a  cause  of  neurasthenia 
than  they  are  of  tuberculosis.  They  create  a  condition 
which  predisposes  to  tuberculosis,  and  which  favours 
the  sowing  and  the  proHferation  of  the  tubercle  baciUus 
which  remains  the  only  true  pathogenic  cause.  In  the 
same  way,  by  the  lowered  psychic  and  physical  tone  to 

^  Prof.  J.  Dejerine  and  Dr.  E.  Gauckler,  P sycho-neuroses  and  Psycho- 
therapy, p.  218. 


THE  EMOTIONS  19 

which  they  subject  the  patient  thej  may  become  factors 
of  a  greater  emotionalism  on  the  one  hand,  as  they  also 
constitute  by  themselves  true  causes  of  emotion  on  the 
other  hand.  But  without  emotion  there  are  no  psycho- 
neuroses."^  On  the  contrary,  an  equally  eminent  French 
neurologist,  Professor  Babinski,  some  years  ago  wrote  : 
"  The  typical  form  of  the  disease  [neurasthenia]  is  repre- 
sented by  what  is  called  constitutional  neurasthenia, 
which  appears  in  youth,  in  subjects  who  until  that  time 
were  able  to  work  intellectually  and  physically  in  a  normal 
way.  The  least  effort  tires  them  ;  they  are  exhausted 
after  reading  a  few  pages  or  writing  a  letter.  This  form 
of  affection  may  be  developed  without  there  having  been 
any  preKminary  over-work,  and  in  individuals  who  are 
not  especially  susceptible  to  emotion."  One  notes  also 
that  the  late  Dr.  Savill,  who  strongly  upheld  a  theory  of 
physical  causation,  was  impressd  by  the  emotive  factor 
as  a  determining  agent.  "  Overwork  is  one  of  the  most 
familiar  causes  [of  neurasthenia]  in  the  experience  of  us 
all ;  too  long  hours,  too  close  attention  to  work  without 
a  break,  and  an  inordinate  desire  to  finish  an  allotted 
task.  One  finds  it  in  busy  city  life,  in  the  keen  struggle 
for  existence,  and  one  finds  it  also  most  frequently  in  the 
autumn  months,  when  men  have  not  been  away  for  some 
time.  Overwork  of  the  mind  is  what  I  am  chiefly  referring 
to,  but  physical  exertion  is  also  a  strain  upon  the  nervous 
systeni.  Prolonged  forced  functioning  of  any  nervous 
structures  undoubtedly  results  in  their  malnutrition  or 
atrophy.  But  it  is  surprising  what  the  nervous  system 
will  tolerate,  and  how  quickly  and  readily  it  will  recuperate 
provided  the  mind  be  free  from  worry  and  anxiety ^^ 

It  is  clear,  then,  that  any  attempt  to  solve  the  problem 
of  nervous  breakdown  requires  full  consideration  of  the 
part  played  by  human  emotions  in  everyday  life.    Hence 

^  Prof.  J.  Dejerine  and  Dr.  E.  Gauckler,  Psycho -neuroses  and  Psycho- 
therapy, p.  232. 

^  T.  D.  Savill,  M.D.,  Lectures  on  Neurasthenia,  p.  60. 


20  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

we  must  for  the  moment  digress  from  our  main  theme 
to  study  just  how  far  emotional  feeling  influences  mental 
rest  or  unrest,  and,  therefore,  to  what  extent  it  affects 
the  question  of  nervousness  or  nervous  instability.  Of 
course,  everyone  knows  what  is  meant  by  the  emotions 
in  a  wide  sense  ;  but  familiar  as  are  these  states  of  feeling 
it  is  not  easy  to  construct  a  comprehensive  but  simple 
definition  of  them.  Webster  defines  emotion  as  "  any  of 
the  feelings  of  joy,  grief,  fear,  hate,  love,  awe,  reverence, 
etc.  ;  any  of  the  feelings  aroused  by  pleasure  or  pain, 
activity  or  repose,  in  their  various  forms,  or  the  type  of 
consciousness  characterized  by  such  feelings."  This 
sufficiently  indicates  as  an  introduction  to  what  follows 
the  particular  mind  states  with  which  we  have  to  deal, 
and  is  a  useful  enough  definition,  especially  when  read  in 
conjunction  with  Webster's  qualifying  statements,  namely, 
that  "  emotion  is  consciousness  attendant  upon  other 
forms  of  consciousness  (as  perception  and  ideation)  to 
which  it  gives  their  feeling  tone  ;  and  emotions  are 
separable  and  classifiable  apart  from  these  other  forms 
because  the  same  object  of  thought  may  at  different 
times  have  a  different  feefing  tone,  as  a  person  may  be 
now  loved,  now  hated.  Sensations  of  pain  and  pleasure 
pass  insensibly  into  pure  emotion.  As  compared  with 
affection  and  feeling,  emotion  is  a  narrower  term  in 
psychology,  though  in  non-technical  usage  both  of  these 
terms  have  the  narrower  meanings." 

From  the  practical  point  of  view  the  first  thing  to  be 
realized  is  the  very  close  connection  that  exists  between 
emotional  feeling  and  bodily  state  ;  indeed,  the  ways  in 
which  a  man's  feelings  are  reflected  in  his  face  and  general 
attitude  are  familiar  enough.  See  how  the  countenance 
fights  up  when  some  friend  approaches  ;  see  how  the 
brow  lowers  and  the  skin  flushes  with  anger  when  an 
adversary  comes  on  the  scene.  The  grief -stricken  man's 
bent  head  and  bowed  shoulders,  the  love-lit  maiden's 
radiant  face,   shining  eyes  and  dancing  footsteps,   are 


THE  EMOTIONS  21 

common  contrasts  of  daily  life  ;  antitheses  that  time  and 
again  have  moved  poet,  painter  and  playwright.  Dignity 
and  pride  are  shown  in  the  upright  bearing,  harmonious 
movements,  the  sedate  speech,  and  firm  expression  of 
those  who  worthily  occupy  responsible  posts.  Ambition 
is  shown  in  set  of  chin  and  cast  of  face,  vigour  of  action, 
and  trenchant  voice.  Do  we  not  in  daily  conversation 
speak  of  a  determined  face,  an  expression  of  weakness, 
an  angry  countenance,  a  proud  demeanour,  an  ambitious 
bearing  ?  And  do  we  not  equally  often  note  jealousy  in  a 
twisted  smile,  treachery  in  a  furtive  glance,  and  honesty 
in  an  open  face  ?  Descriptions  of  men  and  women  gripped 
by  strong  emotion  have  called  forth  some  of  the  greatest 
efforts  of  great  ^vriters  ;  it  is  truly  a  theme  for  the  genius 
of  novelist  or  poet.  And  the  skill  of  the  artist  is  no  less 
seldom  exercised  with  conspicuous  success  in  depicting 
the  play  of  some  profound  f eehng  through  the  human  face 
and  body.  How  graphically  Macbeth's  scornful  ex- 
clamations to  his  frightened  servant  limns  with  the 
touch  of  a  master -hand  a  phase  of  panic  :  "  Thou  cream- 
faced  loon  !  .  .  .  Thou  lily-livered  boy  .  .  .  those  linen- 
cheeks  are  counsellors  to  fear  !  .  .  .  Whey -face  !  "  ^ 
Whilst  where  Agamemnon  says  to  Nestor,  "  What  grief 
hath  set  the  jaundice  on  your  cheek  ?  "  2  one  notes  the 
subtle  difference  between  the  facial  expression  of  the  two 
emotions.  Many  observers  of  human  nature  have  essayed 
the  task  of  describing  in  detail  the  interplay  of  mental  and 
bodily  processes  which  goes  to  make  up  the  familiar 
picture  in  various  emotional  states.  Thus,  of  anger, 
Mantegazza  has  written  :  "  Withdrawal  of  the  head  back- 
wards, withdrawal  of  the  trunk  ;  projection  forwards  of 
the  hands,  as  if  to  defend  one's  self  against  the  hated 
object  ;  contraction  or  closure  of  the  eyes  ;  elevation  of 
the  upper  lip  and  closure  of  the  nose — these  are  all 
elementary  movements  of  turning  away.    Next  threaten- 

^  Shakespeare's  Macbeth,  Act  V,  Sc.  3. 

^  Shakespeare's  Troilus  and  Greasida,  Act  I,  Sc.  3. 


22  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

ing  movements,  as  :   intense  frowning  ;   eyes  wide  open 
display  of  teeth  ;    grinding  teeth  and  contracting  jaws 
opened  mouth  with  tongue  advanced  ;    clenched  fists 
threatening  action  of  arms  ;    stamping  with  the  feet 
deep  inspirations — ^panting  ;   growling  and  various  cries 
automatic  repetition  of  one  word  or  syllable  ;    sudden 
weakness  and  trembling   of  voice  ;    spitting.     Finally, 
various  miscellaneous  reactions  and  vaso-motor  symp- 
toms :   general  trembling  ;   convulsions  of  lips  and  facial 
muscles,  of  Umbs  and  of  trunk  ;   acts  of  violence  to  one's 
self,  as  biting  fist  or  nails  ;    sardonic  laughter  ;    bright 
redness  of  face  ;   sudden  pallor  of  face  ;   extreme  dilata- 
tion of  nostrils  ;   standing  up  of  hair  on  head."^ 

Yet  the  descriptions  of  scientific  men  are  not  usually 
so  much  to  the  point  as  are  popular  phrases  and  proverbs. 
Thus,  to  say  as  we  do  that  someone  shook  with  fear,  his 
hair  stood  on  end  with  fright,  she  was  white  with  anger, 
she  trembled  with  rage,  his  heart  stood  still,  his  heart  was 
in  his  mouth  or  in  his  boots,  his  tongue  clove  to  the  roof 
of  his  mouth — ^to  speak  phrases  such  as  these  is  to  give  a 
touch  of  realism  more  dramatic  and  descriptive  than  any 
scientific  analysis  ever  can. 

Still,  analysis  does  help  us  to  understand  the  close 
association  between  feeling  and  physical  reaction.  Thus 
examining  the  effects  of  grief  one  finds  that  they  are 
manifested  somewhat  differently  in  relation  to  the  tem- 
porary or  settled  nature  of  the  sorrow  felt.  In  the  early 
stage  there  is  an  attitude  of  general  prostration.  The 
whole  system  is  overcome  by  the  storm  that  sweeps  over 
it,  every  function  is  depressed,  even  the  hair  tells  the  tale 
of  trouble,  and  the  floodgates  of  the  eyes  being  opened, 
torrents  of  tears  complete  the  spectacle  of  desolation. 
So  great  is  the  depression  of  vitality  that  appetite  and 
digestion  fail  for  the  time  being  ;  the  heart  may  wilt 
under  the  blow  so  far  that  fainting  occurs  ;    and  in  any 

^  Mantegazza,  La  Physiognomie  et  V expressions  des  sentiments 
quoted  by  Wm.  James,  Principles  of  Psychology. 


THE  EMOTIONS  23 

case  the  exhausted  brain  usually  yields  to  a  soothing 
sleep  that  automatically  descends  and  enfolds  the  sufferer 
in  the  calm  of  oblivion.  On  the  other  hand,  when  the 
first  spasms  of  grief  are  over  and  full  realization  of  loss 
brings  a  settlement  of  misery,  the  picture  is  still  one  of 
depressed  vitaUty,  but  of  a  far  less  prostrating  character. 
Nevertheless,  even  then  the  devitalizing  of  the  system  is 
shown  by  weakness  or  weariness  resulting  in  bent  head, 
bowed  shoulders,  and  di'agging  gait  ;  whilst  the  sagging 
muscles  of  the  face  give  the  characteristic  expression  of 
dejection.  The  "  v/eight  of  sorrow  "is,  indeed,  a  burden 
which  the  system  has  to  "  bear  up  "  against. 

Let  us  now  see  what  happens  in  fear.  Here  the  picture 
is  at  first  one  of  intense  alertness.  The  senses  being  wide 
awake,  the  fear-stricken  man  stands  or  crouches  quite 
still-  with  eyes  widely  open  and  eye-brows  raised  in 
signification  of  heightened  visual  intent,  whilst  the  mouth 
is  open  as  commonly  happens  when  one  wishes  to  hear 
better.  Breath  comes  quickly  and  the  heart  bangs 
against  the  ribs.  The  skin  pales,  and  a  cold  sweat  breaks 
out,  whilst  the  hairs  are  raised  by  spasm  of  the  tiny 
muscles  at  their  roots.  Other  small  superficial  muscles 
also  contract,  "goose-fiesh"  being  thus  produced.  Dry 
mouth  and  husky  voice  complete  the  picture.  Increasing 
emotion  then  hastens  the  violent  action  of  the  heart, 
rigidity  gives  way  to  trembluig  of  limbs  and  chattering 
teeth.  "Lysander,  look  how  I  do  quake  with  fear,"^  cries 
Hermia,  awaking  from  her  fearsome  dream  of  a  serpent 
eating  her  heart  away  whilst  "  you  sat  smiling  at  his 
cruel  prey."  The  Psalmist  sang  :  "  My  flesh  trembleth 
for  fear."2 

As  fear  deepens  to  overwhelming  terror  the  eyes  start 
forwa,rd,  the  lips  move  convulsively,  the  nostrils  dilate, 
and  the  breath  comes  with  difficulty.  At  the  same  time, 
the  whole  frame  is  either  again  stiffened  like  a  statue — 

^  Shakespeare's  Midsummer  Night's  Dream,  Act  II,  Sc.  2. 
2  Psalm  cxix.  120. 


24  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

frequently  some  striking  attitude  being  fixed  in  this  way 
— or  alternatively  there  may  be  wild  movement  of  the 
arms  and  hands.  Moreover,  fear  is  an  emotion  that  when 
felt  intensely  not  uncommonly  distm'bs  the  tranquil 
action  of  the  abdominal  organs  so  that  the  normal  move- 
ment of  stomach  and  bowel  may  be  seriously  disordered. 
Sickness  may  occur,  or,  on  the  other  hand,  there  may 
be  sudden  failm'e  to  retain  the  bowel  contents. 

There  are  few,  if  any,  finer  descriptions  of  what  fear 
means  to  us  than  is  to  be  found  in  those  telling  phrases  of 
the  Book  of  Job  : 

"In  thoughts  from  the  visions  of  the  night, 
When  deep  sleejo  falleth  on  men, 
Fear  came  upon  me,  and  trembling, 
Which  made  all  my  bones  to  shake. 
Then  a  sjoirit  pa^ssed  before  my  face  ; 
The  hair  of  my  flesh  stood  up  : 

It  stood  still,  but  I  could  not  discern  the  form  thereof  : 
An  image  was  before  mine  eyes."^ 

And  so,  with  all  other  emotions,  every  feeling  is  accom- 
panied by  a  corresponding  movement  in  the  physical 
being  and  every  response  of  this  kind  vibrates  in  the 
nervous  system  primarily.  When  we  are  cast  down  by 
grief,  exalted  in  devotion,  torn  by  disappointment  ; 
whether  our  hearts  sweU  with  love,  or  our  senses  are 
pleasantly  thrilled  by  a  fine  day,  the  emotional  feehng  is 
most  assuredly  reflected  in  our  bodies.  Frequently  the 
bodily  response  is  but  fleeting,  but  there  are  some  of  us  so 
constituted — so  impressionable — that  feehng  quite  readily 
stamps  our  organic  make-up  \\ith  a  firm  and  lasting 
impress.  Mary  Tudor,  of  doleful  memory,  spoke  more 
truly  than  she  knew,  if  she  did  indeed  exclaim  in  a  moment 
of  bitter  disappointment,  that  after  her  death  the  word 
"  Calais  "  would  be  fomid  engraved  on  her  heart.  That 
poignant  cry  may  be  taken  as  a  picturesque  expression 
of  a  physical  impress  that  inevitably  occurs  when  we  are 
very  deeply  stirred.    The  emotions  are  legion — love,  joy, 

1  Book  of  Job,  iv.  13-10. 


THE  EMOTIONS  25 

pride,  grief,  fear,  rage,  jealousy,  disappointment,  ambi- 
tion, amusement,  admiration,  devotion,  and  a  hundred 
others — every  minute  of  the  day  influences  the  spinning 
thread  that  is  being  woven  into  the  pattern  of  our  lives. 
The  world  may  be  the  loom,  and  life  the  spinner,  but  the 
emotions  vary  the  pattern  according  as  they  are  much  or 
little  controlled.  Even  when  there  appears  to  be  no  link 
between  sense  of  feeling  and  bodily  reaction — even  when 
our  thoughts  move  freely  on  light  levels  of  intellect  and 
emotion  seems  absent — it  is  true  that,  as  William  James 
put  it  so  well,  "  The  bodily  sounding-board  is  at  work, 
as  careful  introspection  will  show,  far  more  than  we 
usually  suppose."  ^  And  out  of  his  great  experience 
Dubois  wi'ites  :  "  There  is  no  movement  of  the  mind 
without  its  echo  on  the  organism.  We  are  only  able  to 
detect  in  ourselves  and  in  others  the  most  obvious,  the 
coarsest  phenomena.  Moreover,  we  see  emotions  that 
are  whoUy  diverse  expressed  by  the  identical  phenomena 
of  blushing,  growing  pale,  or  by  ordinary  gestures.  We 
see  tears  accompanying  smiles  as  well  as  sobs.  These  are 
gross  macroscopic  reactions.  But  there  are  more  delicate 
and  less  perceptible  phenomena,  which,  under  the  influ- 
ence of  an  idea,  present  themselves  within  the  very  tissues 
themselves.  It  is  this  microscopic  psychophysiology  that 
should  be  studied  in  mental  pathology.  If  we  can,  by  a 
healthy  philosophy  of  life  and  by  moral  hygiene,  suppress 
this  toxic  element  of  emotion,  we  shall  rid  the  greatest 
physical  and  intellectual  fatigue  of  its  harmful  influence." ^ 
The  practical  point,  then,  is  that  our  feelings  are  so 
closely  associated  with  our  bodily  reactions  that  the 
latter — ^particularly  when  our  bodies  are  inherently  deli- 
cate— become  thrown  out  of  gear  just  as  any  other  sensi- 
tive mechanism,  a  watch,  a  magneto,  a  compass,  may  be 
disturbed  by  an  electrical  storm.  Further,  the  cruder 
the  emotion,  the  more  it  is  concerned  with  primitive 

^  Wm.  James,  Principles  of  Psychology,    Vol.  II,  p.  471. 

*  Paul  Dubois,  M.D.,  Psychic  Treatment  oj  Nervous  Disorders,  p.  155. 


26  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

animal  feeling,  the  more  closely  associated  is  it  with 
organic  function,  the  more  violently  it  shakes  the  body. 
Hence  it  is  the  storms  of  passion,  hatred  and  jealousy  ; 
the  reactions  of  love,  courtship  and  marriage  ;  the 
tremors  of  fear — it  is  these  that  shake  the  nervous  system 
to  pieces  far  more  commonly  than  the  reactions  of  ambi- 
tion, pride,  aesthetic  emotion,  intellectual  feeling,  and 
the  hke.  Body  and  subconsciousness,  that  mysterious 
combination  of  evolving  human  phases — possibly  just 
two  phases  of  one  and  the  same  thing — act  and  interact 
so  closely  when  it  is  a  question  of  primitive  feeling  that 
it  is  not  to  be  wondered  at  that  some  psychologists  have 
believed  that  the  coarser  emotions  at  any  rate  are  them- 
selves occasioned  by,  and  in  consequence  of,  particular 
bodily  reactions  in  the  presence  of  special  conditions .  The 
author  finds  himself  in  agreerhent  with  others  who  hold 
that  the  emotion — sense  of  feeling — comes  first,  and  that 
bodily  changes  follow.  But  even  extremists  of  the 
former  school  have  been  of  opinion  that  the  higher 
emotions  are  primarily  founded  in  ideas  ;  recognizing 
that  the  more  intellectual  the  mental  process  the  more 
removed  from  crude  bodily  and  subconscious  reactions. 
This  is  borne  out  every  day  of  our  lives.  Who  has  not 
observed,  time  after  time,  the  failure  of  an  intellectual 
appeal  to  reach  the  foundation  of  some  nervous  trouble  or 
functional  bodily  disorder,  when  the  same  difficulty  at 
once  responds  to  a  crude  "  suggestion  "  which  is  given 
an  emotive  impetus  ?  Intellect  soars  high  above  body 
and  subconsciousness — too  high  at  times  for  our  practical 
convenience,  and  the  intelligent  man  of  affairs  often 
finds  himself  unable  to  reach  unaided  some  troublesome 
"  phobia  "  or  symptom  which  reason  teUs  him  is  baseless 
and  ridiculous,  for  subconsciousness  blunders  on  its  way 
unheeding. 

How  often  do  we  say  of  a  man  that  his  heart  has  run 
away  with  his  head  ;  meaning  that  his  emotions  have 
blurred,    or   warped   his   judgment.      Pascal   well   said, 


THE  EMOTIONS  27 

"  the  heart  has  many  reasons  which  reason  never  knows," 
thus  simply  expressing  a  profound  psychological  truth. 
Mankind  in  our  present  state  of  development  is  tremend- 
ously swayed  by  the  emotions  ;  even  those  comparative 
few  who  rely  on  their  heads  rather  than  on  then  hearts 
are  time  and  again  shaken  out  of  their  intellectual  calm 
by  some  rude  storm  at  lower  levels  to  which  their  very 
disdain  and  neglect  have  largely  contributed.  The 
whole  point  of  education  and  training  should  be  to 
establish  control  of  feehng,  whilst  developing  abihty 
to  express  all  feelings  in  the  most  spuitual  way.  That 
education  so  often  fails  to  guarantee  our  heads  against 
the  riot  of  our  hearts,  and  to  show  us  how  to  protect 
ourselves  against  the  nerve-racking  storms  which  result 
when  heads  and  hearts  come  into  violent  conflict,  is  one 
of  the  most  glaring  defects  of  this  present  civilization. 
Every  one  should  endeavour  to  obtain  control  of  feelings 
throughout  the  whole  gamut  of  the  emotional  scale — 
from  raging  anger,  deadly  fear,  passionate  love,  to  the 
highest  levels  of  spiritual  and  aesthetic  feeling.  Fortu- 
nate are  those  who  by  training  or  temperament  are  able 
to  be  captains  of  their  souls  in  all  weathers.  Around  us 
we  see  the  difference  of  individual  reaction  to  feeling  at 
various  points  of  the  scale.  The  gradation  of  crude 
emotion  to  intellectual  feeling  may  well  be  illustrated  by 
a  comparison  of  the  points  of  view  of  the  critic  and  the 
sentimentalist.  The  former  has  a  cold,  practical  non- 
emotional  sense  of  value.  The  latter  loses  his  intellectual 
concept  in  a  wave  of  emotion  based  on  a  set  of  percep- 
tions rendered  in  terms  of  his  senses  ;  his  pleasure  is 
that  of  romance,  that  is  appreciation  of  things  expressed 
in  pleasurable  bodily  effects,  and  hence  much  more  dis- 
turbing to  nerve  and  bodily  function. 

Conversely  it  foUows  that  the  more  a  man  can  elevate 
his  feeling — the  more  he  can  spirituaMze,  or  intellectualize 
his  thought — the  more  his  nervous  system  is  protected 
agamst  storms  that  threaten  its  security.    This  is  on  all 


28  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

fours  with  the  observation  that  it  is  not  simple  mental 
work  that  leads  to  breakdown,  but  mental  work  accom- 
panied by  emotional  strain — worry,  grief,  jealousy,  dis- 
appointment and  the  rest.  The  clearer  the  thought — 
the  more  our  thinking  processes  are  kept  apart  from 
bodily  feeling,  particularly  in  an  emergency — the  stronger 
the  nerve.  There  are  many  particular  illustrations  and 
applications  of  this.  Thus,  take  the  doctor's  attitude 
towards  disease  and  suffering,  often  a  matter  of  popular 
comment.  He  cannot  feel  deeply  with  all  who  come  to 
him  for  help,  it  is  said ;  surely  familiarity  with  pain  brings 
callousness.  But  what  happens  is  this.  The  doctor 
gradually  exchanges  his  lower  emotional  feeling  for  a 
higher  intellectual  emotional  conception  which  does  not 
disturb  the  harmony  of  his  body,  and  the  latter  thus 
freed  from  disturbance  his  "  nerve  "  no  longer  suffers. 
And  so  the  surgeon  works  out  his  sympathy  in  a  height- 
ened intellectual  process  which  creates  an  appearance 
of  unsympathetic  detachment.  He  intellectualizes — 
spiritualizes — his  emotions  to  the  very  great  interest  of 
his  patient.  Doctors  would  be  in  a  quandary  were  this 
not  so.  What  a  state  of  things  if  every  sad  case  roused 
those  less  intellectual  emotions  which  cause  his  face  to 
pale,  his  heart  to  beat  violently,  his  hands  to  sweat,  his 
eyes  to  fill  with  tears.  His  judgment,  his  professional 
capacity  would  be  centred  in  his  heart  and  his  stomach 
instead  of  in  his  head  !  His  fine  discrimination — his 
saving  nerve — where  would  they  be,  and  what  about  his 
skill  ?  Obviously  the  stronger  the  emotion  the  more 
difRcult  to  intellectualize  it.  There  comes  a  point  when 
lower  centres  will  respond  and  that  bodily  sounding- 
board  vibrate  violently.  Herein  lies  the  scientific  ex- 
planation of  the  circumstance  that  medical  men  feel 
themselves  to  be  i)oor  doctors  to  their  families.  Suffering 
in  one  very  dear  occasions  such  strong  response  of  all 
centres  that  bodily  disturbance  will  occur  and  the  intel- 
lectual   processes — judgment,     and    so    forth— become 


THE  EMOTIONS  29 

depreciated  thereby.  It  requires  vevy  strong  will — a 
very  practised  nerve^ — to  keep  eniotional  feeling  entirely 
in  the  realm  of  intellect  when  the  future  happiness  or 
even  life  of  a  loved  friend  or  relative  hangs  on  one's  pro- 
fessional opinion. 

As  another  illustration,  let  us  take  the  tremendous 
case  of  the  general  upon  whose  judgment  depends 
not  only  the  lives  and  bodies  of  thousands  of  his 
fellows  but  the  fate  of  nations.  His  capacity  to  serve 
his  country  well  is  a  matter  of  his  nerve,  and  is  to  be 
measured  by  his  ability  to  lift  his  feelings  as  far  as 
possible  out  of  the  realm  of  bodily  disturbance  and  to 
intellectualize  them.  Freed  from  the  weakening  con- 
sequences of  visuahzing  the  horrors  resulting  to  friends 
and  individual  units  under  his  command,  v/hich  must 
inevitably  occur  in  v/arfare  whatever  be  his  decision  ; 
and  freed  from  the  contemplation  of  individual  agony  by 
working  mentally  in  the  realm  of  the  intellect,  he  carries 
on  his  great  task  in  the  most  efficient  way.  He  is  not 
callous  ;  not  wantmg  in  feeling.  Far  from  it.  But  he 
raises  his  emotions  above  the  level  at  which  they  would 
send  waves  of  disorder  rushing  through  his  nervous 
system  and  so  hamper  his  powers  of  reasoning. 

Not  a  few  of  those  tragic  failures  in  life  where  the 
trusted  man  suddenly  fails,  to  the  consternation  of  his 
friends,  and  is  overwhelmed  by  a  crisis  everyone  thought 
him  capable  of  handling,  are  due  to  some  unexpected 
inability  to  keep  feeling-tone  on  the  intellectual  plane. 
And  here  let  it  be  remembered  that  the  body  is  insis- 
tent enough  all  the  time  that  it  should  be  allowed  to 
share  in  feeling.  Body  is  insistent  enough  and  requires 
firm  mastery  at  the  best  of  times,  but  when  it  is  ill  or 
tired  or  getting  rather  old  it  manages  to  hamper  intellect. 
The  brain,  of  course,  shares  in  aU  physical  states  of  body  ; 
intellect  depends  on  a  healthy  nervous  system  for  its 
ordinary  expressions,  and  is  clogged  by  a  tired  or  sick 
brain. 


30  THE  PROBLEiM  OF  NERVOUS  BREAKDOWN 

When  the  surgeon  finds  that  his  operative  skill  is 
hampered  by  excessive  emotional  feeling  on  lower  levels, 
so  that  his  hand  trembles,  his  temper  becomes  irritable 
and  his  voice  high-pitched — ^let  him  take  a  hohday.  When 
no  holiday  suffices  to  restore  the  calm  harmony  of  intel- 
lectual control,  then  let  him  think  of  handing  over  his 
scalpel  to  a  younger  colleague  and  devoting  himself  to 
work  of  a  purely  consultant  kind.  When  the  experienced 
officer  finds  his  will  no  longer  able  to  keep  his  feehngs  on 
intellectual  levels  and  his  judgment  becoming  mixed  up 
with  his  heart,  his  breathing,  or  his  bowel — ^let  him  pause 
and  consider  his  state  one  for  review  by  a  sympathetic 
medical  board.  Whether  a  man  controls  an  army  or  a 
business,  whether  he  orders  the  destinies  of  a  thousand 
fellow-workers,  or  is  the  legal  or  medical  adviser  of  a 
single  fellow-creature,  he  can  only  do  his  best  work  when 
he  has  intellectualized — given  the  spiritual  values  of 
clear  thought  and  sound  reasoning — to  his  mental  work. 
The  merit  of  William  Tell's  historic  feat  was  that  he  did 
not  allow  his  emotional  feehngs  to  run  riot  over  his  bod}' 
and  so  destroy  his  nerve  as  to  upset  his  true  aim.  To 
have  shown  more  feeling  in  the  popular  sense — because 
the  only  way  that  feeling  shows  is  through  the  bodily 
disturbance  it  sets  up — would  have  led  to  his  missing 
the  apple  and  transfixing  his  son  ;  yet  the  issue  of  the 
ordeal  to  which  he  was  committed  was  nothing  less  than 
the  fife  or  death  of  his  beloved  child. 

The  practical  application  of  our  understanding  of  the 
emotions  in  regard  to  the  problem  of  nervous  breakdown 
rests  in  its  enablhig  us  better  to  understand  just  under 
what  conditions  emotional  storms  must  try  a  sensitive 
nervous  system.  To  be  thus  forewarned  is  to  be  better 
forearmed  against  neurasthenic  and  similar  states  when 
adverse  circumstances  arise.  Unless  we  comprehend 
how  emotions  influence  bodily  worldngs  and  disturb  the 
balance  of  the  mind,  we  cannot  follow  the  beginning  of 
nervous  disorder,  nor  ca,n  we  satisfactorily  estimate  the 


THE  EMOTIONS  31 

true  value  of  the  various  mental  factors  contributing  to 
a  neurasthenic,  hysterical,  or  allied  illness.  Conse- 
quently, our  next  concern  must  be  with  the  ways  in  which 
emotional  reactions  commonly  disturb  health.  And  we 
may  at  once  note  that  some  people  are  naturally  pre- 
disposed to  distressing  emotional  waves  as  compared 
with  their  less  highly-strung  brothers  and  sisters.  On 
the  other  hand,  we  will  leave  for  the  present  the  detailed 
study  of  the  nervous  temperament  in  its  many  implica- 
tions. 

Let  it  be  understood  at  once  that  each  of  us  exhibits  a 
particular  personal  response  to  emotion.  Just  as  it  is 
rare  to  find  any  two  people  exactly  alike  in  face  and 
physique,  so  it  is  equally  rare  to  find  two  individuals 
alike  in  emotional  response.  Fairly  close  resemblances 
appear  to  be  common,  but  careful  examination  shows 
how  deep  are  the  differences  between  the  feelings  of 
individuals.  If  this  is  so  in  regard  to  the  famUiar  things 
of  life,  how  much  greater  are  the  barriers  between  us  in 
the  more  unusual  relations.  Let  it  be  repeated  that  each 
one  of  us  reacts  in  his  own  peculiar  way  to  emotional 
disturbance,  and  that  in  this  fact  lies  the  explanation  of 
many  strange  nerve  disorders.  Moreover,  the  under- 
standing of  this  enables  us  to  find  ways  of  protecting 
ourselves,  and  seeing  to  it  that  ascertained  tendencies 
to  excessive  reactions  of  feeling  do  not  run  away  with  us, 
but  are  kept  well  in  hand.  To  be  forewarned  against 
particular  emotional  response  is  to  be  protected  against 
overwhelming  storms  threatening  us  from  these  special 
quarters.  Anyone  who  wants  proof  that  the  individual 
always  has  his  own  ways  and  tendencies  in  expression  of 
and  response  to  feeling  has  only  to  look  at  incidents  of 
life  around  him.  Thus,  Smith  can  lose  his  money  cheer- 
fully, but  is  prostrated  by  a  story  of  his  wife's  infidelity. 
Jones,  on  the  other  hand,  shrugs  his  shoulders  at  obvious 
domestic  irregularities — ^jealousy  seems  unknown  to 
him — but  becomes  iU  with  anxiety  should  a  breath  of 


32  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

misfortune  threaten  his  investments.  Robinson,  again, 
seems  able  to  bear  anything  but  the  diminution  of  his 
personal  position  in  the  world.  Indeed,  each  of  us  can 
recall  instances  in  his  own  circle  exemplifying  the  special 
predispositions  of  individuals  to  particular  emotional 
reactions.  Is  it  not  often  noted  how  "  touchy  "  some 
people  are  on  certain  points,  whilst  being  comparatively 
reasonable  on  most  others.  The  jealous  husband  or  wife 
is  a  common  example  of  this.  Emotional  reactions, 
questions  of  temperament,  and  temperamental  differences 
will  be  discussed  at  length  later  on. 

Given  favourable  predisposing  circumstances,  the 
ways  in  which  emotion  may  seriously  disturb  health  are 
for  all  practical  purposes  four  in  number.  Sometimes 
the  intensity  of  feeling  is  so  great  that  it  may  straightway 
wreck  the  whole  delicate  organization  by  which  through 
the  medium  of  the  brain  the  mind-body  system  is  kept 
in  harmonious  action  ;  or,  it  may  serve  as  the  last  straiv 
breaking  the  hack  of  resistance,  and  topple  off  its  throne 
some  already  shaken  human  reason.  On  the  other  hand, 
whilst  an  individual's  nerves  may  have  been  strong 
enough  to  resist  the  original  storm,  or  partly  protected 
from  it  by  some  chance  side-tracking  of  its  violence,  the 
subsequent  memory  of  it  may  be  so  vivid  as  one  day  to 
assume  almost  the  fury  of  its  originator  ;  indeed,  memories 
of  'past  emotions  quite  commonly  act  as  disorganizers  of 
nerve-harmony,  especially  where  remembrance  of  the 
original  emotion  comes  back  repeatedly.  Thirdly, 
emotions  are  dangerous  when  they  are  repressed.  When 
strong  feeling  finds  expression  so  that  the  bursting  storm 
wears  itself  out  its  harmful  possibilities  are  minimised, 
but  emotion  bottled-up  is  liable  to  ferment  and  bubble  in 
the  depths  of  thought.  It  is  stifled  feelings  that  "  work 
like  madness  in  the  brain."  Does  not  a  good  cry  relieve 
pent-up  grief  ?  Does  not  anger  quicldy  spend  itself 
when  it  has  a  speedy  outlet.  Even  bad-tempered  people 
find  it  difficult  to  maintain  their  angriness  at  a  really 


THE  EMOTIONS  33 

impressive  level  for  long  at  a  time.  The  soft  answer  that 
undoubtedly  turns  away  wrath  works  its  soothing  magic 
by  refusing  to  feed  the  flames  of  fury  and  letting  the  fire 
burn  itself  out  quickly,  whilst  by  contrast  showing  the 
rightness  of  peace  as  against  the  fooHshness  of  a  negative 
thing.  Lastly,  the  effort  to  keep  feeling  in  its  place  not 
unseldom  results  in  a  mental  confhct  that  is  extremely 
exhausting,  and  unless  definitely  settled  without  diffi- 
culty may  lead  to  disaster.  The  over-tired  man  or 
woman  who  finds  some  animal  emotion  struggling 
against  higher  conceptions,  or  experiences  a  sense  of 
losing  control  over  morbid  desires,  suffers  very  great 
strain  until  the  fight  is  won.  Facilis  descensus  Averni  ! 
It  is  an  axiom  of  psychology  and  a  rule  of  life,  as  many 
a  proverb  tells,  that  to  win  ground  may  be  hard  indeed, 
but  to  hesitate  always  means  a  grave  set-back. 

The  stage  being  set,  it  is  our  Httle  personal  responses 
that  give  the  accents  to  the  great  picture  of  life's  drama. 
It  is  the  myriad  unexpected  reactions  of  individuals  to 
the  common  interests  of  life  that  give  endless  oppor- 
tunities for  poet,  dramatist  and  novehst  to  weave  their 
fascinating  skeins.  It  is  the  excessive  and  often  morbid 
response  in  certain  directions  that  gives  the  practical 
psychologist  inexhaustible  material  for  study — a  most 
interesting  field  of  work — and  exceptional  occasions  for 
helping  many  a  sick  soul  out  of  the  Slough  of  Despond. 
But  in  the  wrecking  of  nerves  it  is  emotional  responses 
and  conflicts  tha.t  excel  over  all  other  reactions.  Hard  as 
it  is  to  understand  how  a  thing  that  has  been  forgotten, 
how  a  M^ave  of  feehng  that  has  been  quickly  thrust  aside, 
can  persist  as  an  active  agent — and  steadily  undermine 
health — ^the  fact  remains  that  this  is  so.  Analysis  of 
thought,  intuitions  and  dreams  has  proved  bej^ond  the 
possibility  of  doubt  that  there  are  dark  caverns  of  men- 
tality — subconscious  depths — in  which  lurk  horrid  shapes 
and  monsters  of  crude  emotion.  Further  psychological 
research  has  proved  no  less  surely  that  these  goblins  and 


34  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

phantasms  of  past  experience  and  unfulfilled  passion  are 
powerful  for  our  ■  destruction  under  certain  conditions. 
Particularly  if  we  fear  them,  or  excite  them  by  sending 
them  companions  of  their  kind,  do  they  become  restless 
and  seek  to  devour  us.  But  to  bring  them  out  into  the 
light  of  full  consciousness,  to  demonstrate  that  they  have 
no  real  power,  is  to  show  them  up  for  what  they  are  worth. 
Wraiths  and  ghosts  of  a  transient  hate,  a  flash  of  anger 
suppressed,  a  consuming  love  unfulfilled — these  spectres 
vanish  into  smoke  when  confronted  with  the  eye  of  under- 
standing and  confidence. 

Conflicts  distract  the  thought  and  tear  the  nervous 
system  when  the  higher  cannot  hold  the  lower  and  help 
is  not  sought  to  sway  the  balance  in  favour  of  our  better 
nature.  Such  struggles  may  occur  round  memories  and 
repressions  as  round  immediate  emotional  disturbances. 
As  soon  as  a  conflict  is  set  up,  that  is  to  say  as  soon  as  the 
individual  can  only  maintain  his  nerve  by  a  constant 
fight  for  his  intellectual  position,  then  he  is  no  longer  fit 
for  good  work.  Where  the  officer,  or  the  surgeon,  or  the 
lawyer  is  able  to  make  his  decisions  without  any  very 
noticeable  effort  of  will  being  required  to  suppress  his 
emotion,  without,  indeed,  those  emotions  tending  to 
display  themselves  on  lower  levels',  then  excellent  work 
can  be  done.  But  as  soon  as  an  effort  is  required  it  means 
that  nerve  is  impaired  and  a  rest  should  be  taken.  If 
responsible  duties  are  persisted  with  under  such  condi- 
tions of  mental  conflict  as  are  herein  indicated,  then,  if 
the  individual  is  not  capable  of  almost  superhuman 
effort,  emotional  feeling  will  eventually  overflow  the 
barriers  of  Will  and  send  such  violent  waves  of  reaction 
throughout  the  body  that  the  nervous  system  will  no 
longer  be  able  to  perform  its  work  and  general  coUapse 
will  occur.  This,  in  a  word,  is  the  story  of  a  thousand 
nervous  breakdowns  in  men  and  women  who  have  previ- 
ously done  good  work. 

We  have  Dr.  Charles  Burr's  authority  for  the  state- 


THE  EMOTIONS  35 

ment  that  in  the  United  Sta.tes,  just  as  in  this  country, 
emotional  stress  is  a  much  more  important  factor  than 
physical  overv/ork  in  the  production  of  neurasthenia. 
He  states  :  "  Mental  work,  even  if  carried  to  excess,  pro- 
vided it  is  not  accompanied  by  worry,  is  not  a  frequent 
cause, but  when\vorryis  present  neurasthenia  is  frequent."  ^ 
As  illustra-ting  the  prominence  of  the  emotional  factor 
in  bringing  about  particular  breakdo\vTi  or  "  nervous 
attacks  "  one  may  note  the  following  examples  of 
operative  mental  causes  : 

1.  A  young  married  woman  had  been  neurasthenic 
for  some  years  with  particular  "  attacks."  During  the 
latter  she  exhibited  violent  temper.  Inquiry  eUcited  the 
facts  that  she  had  had  violent  disagreements  with  her 
husband,  and  that  there  was  great  incompatibility  of 
temperament  betiveen  them,. 

2.  A  middle-aged  tradesman  became  afflicted  with 
depression,  giddiness,  indigestion  and  neuralgia  with 
domestic  trouble,  luhich  ended  in  his  having  to  divorce  his 
wife,  of  whom  he  luas  apparently  very  fond. 

3.  A  journalist  became  neurasthenic  after  suffering 
the  combined  strain  of  overwork  and  worry  about  re- 
sponsibilities. 

4.  Numerous  instances  appear  in  one's  notes  of  people 
developing  neuralgia  or  headache  when  having  to  follow 
distasteful  occupations  or  to  work  with  uncongenial  com- 
panions. 

5.  A  superstitious  young  woman  became  sleepless  and 
ill  through  constant  fear  that  a  sujjposed  omen  ivoidd  be 
fulfilled  to  her  detrrnient. 

6.  A  business  man  became  highly  nervous  and  fatigued 
after  a  period  of  do^nestic  ivorry,  in  the  course  of  which  he 
separated  from  his  wife. 

7.  Serious  and  persistent  neurasthenia  invalided  a 
very  active  woman  after  the  sudden  and  entirely  unex- 
pected death  of  her  husband. 

^  Osier's  System  oj  Medicine,  Vol,  V,  p.  626. 


36  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

8.  Concerning  a  successful  business  man  suffering  from 
numerous  neurasthenic  symptoms  the  note  was  made, 
"  obvious  emotional  factor  relating  to  anxiety  about  his 
affairs." 

9.  A  man  experienced  an  accident  in  which  a  wall  fell 
on  him  and  a  fellow-worker  ivas  hilled.  Although  very  little 
hurt,  he  developed  a  serious  and  persistent  neurasthenia. 

10.  Widow,  aged  43,  became  neurasthenic  with  dis- 
turbed sleep,  depression,  mental  and  physical  fatigue, 
loss  of  memory  and  digestive  trouble  following  a  great 
deal  of  domestic  worry. 

11.  Young  unmarried  woman  complained  of  mental 
and  physical  fatigue,  severe  headache,  digestive  trouble 
and  attacks  of  faintness.  Herself  attributed  the  iOness 
to  domestic  worry. 

12.  A  tradesman  suffered  from  neurasthenia,  fatigue, 
a  sense  of  "  specks  "  in  front  of  eyes.  He  had  much 
business  worry. 

13.  A  lady  complained  of  loss  of  confidence,  depression, 
fatigue,  sense  of  failing  in  interest  and  severe  headache, 
said  she  had  had  much  private  worry. 

14.  A  young  woman  said  that  she  attributed  her 
neurasthenic  state  (including  depression,  and  want  of 
interest),  to  having  kept  to  herself  an  anxiety  about  frequent 
flushing  in  public. 

15.  Severe  neurasthenia  occurred  in  a  married  woman 
following  prolonged  overwork  combined  with  domestic 
worry.  Was  apparently  still  in  love  with  her  first  husband, 
from  whom  she  was  divorced. 

16.  Professional  man,  aged  52,  broke  down  after  shock 
and  domestic  worry. 

17.  In  the  case  of  a  young  married  woman  in  whom 
neurasthenic  symptoms  appeared  it  was  surmised  that 
the  morbid  conditions  present  were  due  to  a  suppressed 
emotional  conflict.  She  was  married  to  a  man  older  than 
herself,  and,  although  particularly  wishing  for  a  son,  had 
no  children. 


THE  EMOTIONS  37 

18.  Numerous  cases  have  appeared  to  be  largely  due 
to  a  sense  of  disappointment  or  dissatisfaction  with  the 
sufferer's  position  in  life.  Retirement  from  official  work, 
and  want  of  occupation  following,  would  come  under 
this  heading. 

19.  A  young  woman  suSering  from  mental  and  physical 
exhaustion  with  attacks  of  anxiety,  great  restlessness 
and  neuralgic  pains  had  previously  been  greatly  upset 
by  a  love  affair. 

20.  In  the  case  of  a  widow  between  50  and  60  years  of 
age,  breakdown  followed  immediately  on  her  husband's 
death. 

21.  A  man  who  had  successfully  borne  the  strain  of 
many  years  hard  official  work  broke  down  when  his 
affairs  became  complicated  by  a  disturbing  love  affair, 
he  being  a  married  man. 

22.  In  many  instances  a  neurasthenic  condition  has 
been  observed  to  develop  after  the  death  of  a  near  friend 
or  relative. 


CHAPTER  III 

NERVOUS   TEMPERA^klENT 

Nervousness — Temperament  and  character — Reaction  to  euviron- 
meat — -Types  of  temperament — The  nervous  temperament^ — Tem- 
peramental blends — Normal  and  abnormal  nervousness — Eccen- 
tricity— National  temperaments — Degeneracy — Genius  and  mor- 
bidity— The  ex-Kaiser  as  an  interesting  study  in  temperament. 

THERE  are  numerous  ]Deople  who  by  reason  of  cer- 
tain familiar  characteristics  we  say  are  "  nervous  "  ; 
meaning  by  this  they  are  quick  in  response,  highly-strung, 
over-sensitive  in  both  mind  8.nd  body,  subject  to  dis- 
turbances of  sleep  and  digestion,  greatly  bothered  by 
aches  and  pains  that  do  not  trouble  theh'  fellows,  in- 
capable of  very  prolonged  exertion,  yet  withal  frequently 
intellectual,  ambitious  and  successful.  In  other  words, 
this  nervousness  shows  all  our  most  live  qualities  raised 
to  a  high  power  ;  its  intense  emotionalism  separating  it 
out  as  a  type.  And  as  in  the  preceding  chapter  we  have 
seen  how  emotional  reaction  so  commonly  over-strains 
the  nervous  system,  now  we  are  to  see  how  certain  people 
are  so  temperamentally  constituted  that  they  are  especi- 
ally predisposed  to  excessive  feeluig  response,  and  con- 
sequently are  more  than  their  feUows  liable  to  neuras- 
thenic and  similar  troubles.  To  understand  how  this  is 
so  necessitates  a  brief  study  of  what  we  understand  by 
temperament. 

Variously  defined,  temperament  is  really  the  inherent 
tendency  of  the  individual  to  react  to  particular  influ- 
ences and  conditions.  It  is  therefore  personal.  We  have, 
indeed,  already  noted  that  each  of  us  exhibits  his  own 

38 


NERVOUS  TEMPERAMENT  .  39 

special  ways  of  responding  to  emotional  waves,  and  it  is 
the  sum-total  of  our  personal  reactions  that  forms  that 
general  response  to  the  calls  of  the  world  and  society 
that  constitutes  temperament.  Deeply  rooted  in  all 
those  factors  that  have  gone  to  help  in  constructing  the 
fabric  of  the  human  soul,  moulded  by  those  which  have 
differentiated  one  race-mind  from  another,  and  then  one 
tj^e  of  individual  from  another,  our  temperaments  are 
to-day  the  basis  of  our  lives.  Far  from  being  hopelessly 
unpliable,  personal  mental  constitution  as  expressed  by 
temperament  is  certainly  hard  to  remould,  and  on  this 
innate  and  notably  firm  foundation  of  temperament  each 
of  us  builds  the  super-structure  of  character.  Moreover, 
as  the  latter  is  the  last  to  develop  so  it  is  inevitably 
the  less  resistant  to  internal  or  external  influences. 
Character  can  be  so  trained  as  to  minimize  the  dis- 
advantages of  temperament,  where  it  is  found  too  hard 
a  task  to  modify  the  latter  ;  character  so  formed  in 
opposition  to  morbid  kinds  of  temperament  then  acts 
as  a  steady  influence  modifying  its  own  foundations  for 
good.  It  follows,  then,  that  an  important  aspect  of  our 
problem  is  that  which  concerns  the  character-building 
of  nervous  children,  so  that  their  education  shall  give 
them  a  sound  protection  against  the  deleterious  tenden- 
cies they  start  life  with.  To  make  our  characters  masters 
of  our  temperaments  should  be  our  ideal ;  where  we  are 
of  nervous  predisposition  it  must  be  an  early  goal.  To 
form  a  fine  character  always  denotes  a  victory  of  mind  ; 
to  conquer  a  vile  temperament  is  always  a  great  spiritual 
triumph.  For  character  to  be  the  servant  of  tempera- 
ment is  always  unfortunate  ;  for  the  neurasthenic  it  is 
disastrous. 

Temperamental  peculiarities  bring  it  about  that  various 
people  show  such  remarkable  aptitude  for  certain  work 
and  offices  that  we  say  they  are  "  born  to  "  their 
occupations.  These  are  they  who  so  successfully  "  fit 
into  "  the  envu-onment  in  which  they  find  themselves— 


40  THE  PROBLEM  OP  NERVOUS  BREAKDOWN 

or  wherein  opportunity  leads  them  or  chance  thrusts 
them — that  they  go  straight  ahead  and  achieve  success 
with  meteoric  rapidity.  They  occupy  the  centre  of  the 
stage  and  are  the  cynosure  of  all  eyes.  Cromwell  was 
a  born  leader  and  a  born  statesman  ;  Napoleon  was  born 
to  leadership  and  strategy.  The  born  doctor,  actor, 
lawyer,  we  see  all  round  us  ;  their  fitness  for  their 
opportunities  gives  them  a  headlong  start  in  life's 
handicap.  But  it  is  no  good  being  "  born  to  "  certain 
work  if  opportunity  never  comes  to  exercise  inherent 
gifts,  or  if,  in  sportive  vein.  Nature  has  denied  the  ability 
of  making  opportunities  for  individual  ends. 

At  the  other  end  of  the  scale  we  find  those  who,  sadly 
enough,  do  not  fit  into  their  environment.  Some,  indeed, 
are  so  miserably  situated  that  they  find  themselves 
always  unsuited.  Misfits  are  for  ever  with  us  ;  they  are 
for  the  most  part  the  poor  in  nerve.  The  solution  of  our 
problem  must  include  the  consideration  of  these,  for 
amongst  them  are  many  who  with  help  would  certainly 
play  a  useful  if  small  part,  and  so  contribute  that  much 
to  the  commonwealth.  They  include,  of  course,  those 
who  owing  to  stress  of  war  quickly  break  down  under  the 
conditions  of  military  service  ;  the  "  martial  misfits," 
as  some  one  has  dubbed  them.  The  fault  is  certainly  not 
theirs.  The  remedy  for  nervous  misfits  is  to  secure  them 
work  they  feel  capable  of  and  which  will  enable  them  to 
do  their  best  as  units  in  the  great  machine  of  State, 
instead  of  crushing  whatever  abilities  they  may  possess 
in  unwise  attempts  to  fit  these  square  pegs  into  round 
holes.  Only  bj?^  studying  temperament  as  well  as  physique 
can  we  see  to  it  that  we  always  have  the  best  man  for  the 
job.  Estimation  of  general  physique  and  the  state  of  the 
physical  nervous  system  is  not  enough.  Temperament 
is  the  physique  of  the  individual  mind,  and  much  greater 
attention  should  be  given  to  it  in  selecting  candidates 
for  posts  of  any  kind.  Now  that  our  future  lies  largely 
in  the  air  there  are  going  to  be  endless  opportunities  for 


NERVOUS  TEMPERAMENT  41 

mistakes  ;  many  misfits  may  be  given  work  that  will 
endanger  their  own  lives  as  well  as  those  of  their  fellows 
if  this  question  of  temperament  is  not  properly  taken  up. 
Temperament  in  relation  to  aviation  opens  a  new  field 
of  research  that  is  of  vital  importance  to  national  welfare 
in  commerce  and  security  in  war.  Already  one  can 
estimate  with  a  little  more  accuracy  than  was  possible 
two  or  three  years  ago,  some  of  those  temperamental 
factors  which  point  to  the  successful  aviator  and  to  the 
aerial  unfit. 

Differences  of  temperament  have  been  observed  from 
very  ancient  times,  and,  indeed,  in  the  early  days  of 
medicine  temperament  played  as  important  a  part  in  the 
diagnostic  reckonings  of  physicians  as  do  our  scientific 
instruments  to-day.  Doctors  of  old  times  knew  nothing 
of  X-rays,  chemical  analysis,  microscopes  or  apparatus 
for  testing  the  heart  or  other  organs,  but  they  were  studi- 
ous observers  of  human  nature.  And,  as  a  result  of  look- 
ing closely  for  divergencies  of  temperament,  they  eventu- 
ally classified  mankind  according  to  sanguine,  bilious, 
melancholic  and  phlegmatic  temperaments.  To-day, 
whilst  perhaps  not  recognizing  quite  the  same  character- 
istics in  these  types,  we  are,  nevertheless,  familiar  enough 
with  many  of  the  features  which  led  to  this  division. 
Thus  it  is  interesting  to  recall  how  one  associates  the 
sangume  temperament  with  fairness  of  skin,  reddish 
hair  and  blue  eyes  ;  accompanied  on  the  mental  side  with 
quick  emotions,  active  brains,  but,  sad  to  say,  often  some 
lack  of  persistency  in  thought  and  conduct.  Contrast 
this  with  the  more  sober  and  steady  qualities  of  those 
who,  dark  in  eyes,  hair  and  complexion,  exhibit  the 
mental  characteristics  of  depth,  caution,  determination, 
and  ambition  ;  or,  again,  with  those  heavy  persons,  pasty 
in  face,  slow  in  movement,  very  cautious  but  plodding  in 
all  mental  activities  and  readily  depressed,  who  would 
come  within  the  ancient  definition  of  phlegmatic.  To- 
day, as  already  noted,  we  recognize  the  nervous  constitu- 


42  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

tion — which  Hippocrates  and  his  fellows  would  probably 
have  called  the  melancholic  temperament. 

Ribot,  in  his  interesting  work  on  the  emotions,  endea- 
vom'ed  to  simplify  matters  by  distinguishing  two  broad 
tjrpes  :  sensitive  and  active.  Of  these  the  sensitive  really 
represents  a  combination  of  the  nervous  and  bilious,  and 
the  active  a  blend  of  sanguine,  bilious  and  nervous.  But 
the  learned  professor  then  found  that  he  had  to  admit  a 
third  type,  which  he  called  the  apathetic,  corresponding 
to  the  old  phlegmatic  temperament  ;  and  eventually 
found  himself  unable  to  place  that  very  common  make- 
up which  expresses  moderation  in  all  things,  and  so 
actually  added  a  fomth  which  he  called  temperate.  Thus 
one  sees  that  if  it  is  attempted  to  define  definite  types  of 
temperaments  too  closely  it  is  very  hard  to  improve  on 
the  division  into  sanguine,  bilious,  phlegmatic,  and 
melancholic  v/hich  satisfied  ancient  philosophy  and  the 
great  Greek  doctors  who  founded  medical  science.  In- 
deed, one  could  go  on  making  classifications  indefinitely 
without  coming  to  any  better  understanding  of  the 
problem,  particularly  when  one  realizes  that  modern 
man  by  virtue  of  his  mixed  descent  exhibits  a  blend  of 
many  previous  race  characteristics.  Daniel  Defoe  well 
said  of  ourselves,  "  a  true  born  Englishman's  a  contra- 
diction, in  speech  an  irony,  in  fact  a  fiction," 

Unquestionably  in  studying  the  part  played  by  tempera- 
ments in  favouring  or  protecting  against  nervous  break- 
down the  best  thing  to  do  is  to  realize  that  the  classifica- 
tion into  definite  tjrpes  is  simply  a  matter  of  academic 
convenience,  enabling  us  to  recognize  the  common 
association  of  certain  mental  and  physical  differences 
and  also  helping  us  to  recognize  blends  of  these  associa- 
tions. We  must  not  go  out  into  the  street  expecting 
everyone  we  meet  to  exemj)lify  pure  types  of  particular 
temperaments  according  to  some  enthusiast's  classifica- 
tion. Mixtures  we  are,  and  mixtures  shaU  remain  until 
some  future  century  produces  that  perfect  type  towards 


NERVOUS  TEaiPERAMENT  43 

which  one  may  hope  the  evolution  of  mankind  is  tending. 
For  each  individual  the  actual  self  at  any  moment  as 
related  to  the  world  represents  a  combination  of  three 
interdependent  factors  :  (1)  Physical  state  ;  (2)  Emotional 
condition ;  (3)  Intellectual  attitude.  Of  these  the  first  two 
are  very  closely  related,  as  we  have  seen,  whilst  the  third 
is  to  some  extent  independent.  Within  certain  limits 
this  combination  is  recognized  as  normal,  but  when  there 
is  such  want  of  balance  that  one  is  out  of  harmony  with 
the  others,  or  that  1  and  2  are  found  in  conflict  with  3, 
breakdown  occurs,  as  shown  by  neurasthenic  and  morbid 
mental  states.  "  The  practically  real  world  for  each  one 
of  us,  the  effective  world  of  the  individual,  is  the  com- 
pound world,  the  physical  facts  and  emotional  values  in 
indistinguishable  combination.  Withdraw  or  pervert 
eitlier  factor  of  this  complex  resultant,  and  the  kind  of 
experience  we  call  pathological  ensues."  In  studying 
this  question  one  should  note  just  what  are  those 
characteristics  which  commonly  stand  out  so  boldly 
as  definitely  to  colour  specific  temper amxcnts.  They 
include  hopefulness,  optimism,  cheerfulness,  or  sen- 
sitiveness, i.e.  impressionabihty  which  may  be  (a) 
superficial,  (b)  deep — a  very  important  matter ;  pessimism, 
desire  for  action,  determination  and  persistency,  caution, 
phlegm  as  exhibited  by  slowness  in  thought  and  deed, 
mischievousness.  Each  individual's  temperament  is 
really  a  resultant  ;  and  the  features  by  which  he  is  best 
kno'wai  to  his  fellows  are  emphasized  by  just  those  charac- 
teristics which  are  most  prominently  present.  It  is  when 
some  happy  blend  of  temperament  occurs  that  we  find 
a  man  or  woman  outshine  the  rest  in  thought,  word, 
or  deed.  Some  of  the  world's  greatest  men  and  women 
have  been  compounded  of  the  dark,  cautious  type, 
admixed  with  sanguine  and  nervous  features.  To  those 
who  are  fortunate  enough  to  be  brightly  sanguine  in  out- 
look whilst  strong  in  build,  sure  in  thought,  but  neverthe- 
less quick,  comprehensive  and  imaginative,  all  things  are 


44  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

possible.  These  are  they  who  successfully  carry  out 
enterprises  requiring  dash  and  swift  virility.  They  have 
no  fear,  and  on  land,  on  the  sea  or  in  the  air  will  always  do 
great  deeds.  One  thinks  of  Harold  the  Saxon  King,  of 
Richard  Cceur  de  Lion,  of  Francis  Drake,  of  Nelson  and 
of  many  a  brave  boy  lately  "  gone  west."  Similarly,  a 
blend  of  the  nervous  constitution  will  change  one  who 
would  otherwise  have  been  a  phlegmatic  individual 
into  a  dashing  hero  or  heroine,  or  into  an  inventive 
genius  who  becomes  a  national  asset.  One  knows 
that  many  weU-known  men  have  owed  their  success, 
or  been  influenced  at  critical  stages  of  their  careers, 
by  particular  temperamental  characteristics.  Thus 
one  finds  many  famous  leaders  of  men  have  been 
either  primarily  of  the  choleric  type,  whilst  truly 
sanguine  and  sensitive  (nervous)  at  the  same  time, 
or  primarily  nervous  with  just  sufficient  blending  of 
phlegm  to  steady  them.  Amongst  the  former  one 
thinks  of  Julius  Caesar,  Oliver  Cromwell  and  Cardinal 
Wolsey  ;  amongst  the  latter  William  of  Orange.  Where 
the  nervous  temperament  has  run  riot,  controlled  merely 
by  a  degenerate  cunning,  such  monsters  as  Richard  III  of 
England,  and  Ivan  the  Terrible  of  Russia  have  scourged 
humanity.  One  finds  that  writers  of  fiction  like  to  endow 
their  heroes  with  just  that  satisfactory  admixture  of  the 
firm  choleric  type  and  a  certain  sanguine  nervousness 
sufficient  to  make  them  noble,  adventurous,  energetic 
and  magnificent.  Of  just  the  right  temperament  for  a 
hero,  D'Artagnan  holds  the  field  in  The  Three  Mus- 
keteers, and  captures  all  hearts.  Shakespeare's  Hotspur 
and  splendid  Prince  Hal  are  equally  gallant  ;  whilst 
King  Arthur  and  his  Knights  of  the  Round  Table  stand 
out  for  all  time  as  the  most  perfect  examples  of  this 
fortunate  type. 

One  would  like  to  survey  at  length  the  representations 
of  temperament  as  portrayed  by  some  famous  novelists. 
In   the   pages   of   Dickens   alone  one  can  find  enough 


NERVOUS  TEMPERAMENT  45 

material  for  a  whole  volume.  There  we  encounter 
different  types  depicted  with  a  masterhand  and  ex- 
emplifying every  familiar  mixture  of  those  innate 
mental  qualities  which,  as  we  have  seen,  go  to  make  up 
temperaments.  So  true  to  life,  indeed,  are  these  types 
that  the  names  of  many  Dickensian  characters  stand  as 
household  equivalents  of  various  ways  of  reacting  to  life. 
The  kindly  benevolence  of  Mr.  Pickwick,  the  undaunted 
optimism  of  Mr.  Micawber,  the  irrepressible  jolHty  of 
Mark  Tapley,  the  unctuous  meanness  of  Mr.  Pecksniff, 
and  the  insidious  humility  of  Uriah  Heep  at  once  come 
to  mind. 

Exaggeration  of  certain  temperamental  characteristics 
far  more  often  leads  to  an  individual  being  obviously — 
and  therefore  abnormally — "  nervous  "  than  it  does  to 
noticeable  breakdown.  But  it  is  none  the  less  true  that 
where  there  is  a  diversion  of  thought  and  physical  energy 
to  the  setting  up  of  eccentricities  or  other  forms  of  mental 
defensive  machinery,  there  is  to  greater  or  less  extent  a 
breakdown  of  that  smooth  harmonious  relationship 
between  the  individual  and  his  environment  that  is  the 
ideal  of  happy  healthy  life.  Of  course  it  is  only  when 
the  jars  and  disharmonies  are  such  that  the  nervous 
system  is  unable  to  maintain  harmony  of  thought  and 
action  that  the  resultant  mind-body  condition  is  recog- 
nised as  an  indication  of  actual  breakdown.  It  is  thus, 
then,  that  the  individual  concerned  becomes  definitely 
a  "  patient  "  suffering  from  "  neurasthenia,"  or  some 
allied  trouble.  It  has  been  said  that  the  nervous  are  the 
salt  of  the  earth,  but  that  is  not  to  say  the  neurasthenic. 
What  is  true  is  that  a  blend  of  nervousness  often  gives 
just  that  fire  and  force  that  enables  a  man  to  manifest 
his  finest  characteristics  and  do  his  best  work.  Just  as, 
on  the  other  hand,  the  bright,  happy  life  of  the  sanguine 
may  be  spoiled  by  a  dash  of  viciousness  ;  its  sweetness 
soured  by  selfishness  and  morbid  jealousies.  Similarly 
too  great  a  preponderance  of  lively  emotionalism  obscures 


46  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

any  possible  advantages  of  the  nervous  temperament, 
and  if  uncontrolled  results  in  failure  and  ill-health. 

Eccentricity  often  represents  a  self -defensive  mechanism 
set  up  by  morbidly  sensitive  people  who  directly  or 
indirectly- — usually  quite  unconsciously — have  elabo- 
rated this  means  of  getting  away  from  the  things 
of  ordinary  life  that  worry  and  irritate  them.  Eccen- 
tricity is  so  commonly  found  in  nervous  persons 
because  it  is  just  those  who  manifest  over-sensitiveness 
and  react  abnormally  on  the  emotional  side.  Hence 
then'  eccentricities  tend  to  protect  them  from  what  is  to 
them  the  unbearable  rough  and  tumble  of  the  work-a-day 
world  and  they  develop  habits  of  seclusion,  of  compara- 
tive irregularity,  of  devious  ways  of  living.  In  detail, 
eccentricity  is  governed  by  a  number  of  secondary 
factors  which,  in  course  of  time,  frequently  lose  their 
original  force,  but,  nevertheless,  leave  habits  behind 
them  when  this  particular  form  of  nervous  self-defence 
originally  set  up  no  longer  is  needed.  Many  eccentricities 
of  conduct  are  in  the  first  place  quite  consciously  per- 
formed by  nervous  people  who  have  a  perfectly  sensible 
reason  from  their  point  of  view  ;  but  the  same  over- 
sensitiveness  that  led  to  the  eccentricity  prevents — by 
fear  of  unsympathetic  criticism — the  indi\Hdual  con- 
cerned from  confiding  the  reason  for  his  little  tricks  even 
to  his  closest  friends.  It  is,  after  all,  his  business,  and  he 
lets  outside  opinion  go  hang  ! 

One  recognizes  national  as  well  as  individual  tem- 
peraments. National  temperamental  tendencies  be- 
come modified  by  training  and  environment.  It  has 
been  said  that  "  the  long  and  severe  training  of  the 
tribes  of  Central  and  Northern  Europe  explains  their 
pugnacious  qualities,  which  compare  so  strongly  with 
the  people  of  China  and  India  who  embraced  Buddhism, 
the  religion  of  peace  and  inertia."  ^    In  many  countries 

^  T.  Claye  Shaw,  M.D.,  The  Psychological  Influences  Affecting  War. 
a.  Medical  Press  and  Circular,  May  19th,  1915. 


NERVOUS  TEMPERAMENT     '  47 

to-day  the  fighting  temperament  has  been  so  modified  by 
training  that  it  has  been  transformed  into  the  gentler 
experience  of  industrial  competition  and  friendly  rivalry 
in  sport.  According  to  those  conceptions  which  we  and 
our  allies  in  the  great  war  feel  must  be  representative 
of  the  best  types  of  civilization  so  far  attained  this  is  a 
definite  advance  in  the  evolution  of  national  tempera- 
ments. That  it  is  not  so  considered  by  those  tribes  of 
Central  Europe  just  referred  to  has  been  unpleasantlj'^ 
forced  on  our  attention. 

How  prominently  the  morbid  developments  of  the 
nervous  temperament  have  figured  in  the  lives  of 
many  who  have  left  their  mark  upon  the  world,  is 
amply  illustrated  in  the  pages  of  history.  Certainly  it 
often  has  happened  that  when  a  family  constitution  is 
largely  based  on  the  nervous  temperament,  the  further 
blending  has  led  to  both  flights  of  brilliant  genius  and 
depths  of  depression  and  despair  in  individual  members. 
Nevertheless,  brilliancy  of  intellect  is  by  no  means  always 
or  necessarily  associated  with  mental  degeneracy.  Shelley, 
Sheridan,  Sn  Walter  Scott,  Robert  Burns,  Wordsworth, 
and  Byron  all  shone  in  a  firmament  of  neuroticism. 
Cowper,  who  is  said  to  have  written  John  Gilpin  when 
suffering  from  intense  melancholia,  came  of  a  family 
previously  exhibiting  both  mental  instability  and  great 
fame.  Of  the  family  of  another  famous  poet,  we  are 
told  that  "  his  father  was  eccentric  and  absent-minded, 
and  his  mother  is  stated  to  have  been  uneducated 
and  simple.  He  himself  ran  away  from  coUege,  he 
quarrelled  with  his  brother  as  a  boy,  and  left  home, 
being  absent  all  night  without  apparent  reason.  Later 
in  life  he  left  his  wife  and  children  and  v/ent  off  to  Malta. 
At  the  age  of  thirty  he  was  broken  down,  and  he  died  a 
wreck  whilst  his  son  drank  himself  to  death  and  died 
demented."  ^    Yet  another  shone  as  the  brilliant  star  of 

^  Sir  Robert  Armstrong-Jones,  M.D.,  Temperaments  :  la  there  a 
Neurotic  One  ?    Cf.  The  Lancet,  Jiily  let,  1911. 


48  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

a  highly  unstable  family,  amongst  his  uncles  being  one 
who  left  his  estate  to  a  footman.  On  tracing  inheritance 
and  mental  reaction  in  the  biographies  of  some  of  the 
most  eminent  musicians,  we  can  find  the  same  penalty 
exacted  from  families  which  have  produced  geniuses. 
"  The  genealogy  of  the  Bach  family  has  been  traced  for 
200  years,  from  the  founder,  who  was  a  baker,  to  Sebas- 
tian Bach,  the  climax  of  musical  talent.  Bach  had 
twenty  children,  but  no  issue  remains  to  perpetuate  the 
distinctions  of  the  father.  Although  many  of  the  Bachs 
married  musical  people,  the  family  record  is  one  of  sick- 
ness, bhndness,  drunkenness  and  mental  defect.  Although 
we  can  breed  Arab  horses,  Derby  winners,  and  prize 
cattle,  it  has  hitherto  not  been  possible  to  produce  a 
"  musical  breed,"  showing  the  unfitness  of  genius 
to  survive  in  a  world  requiring  many  adaptations, 
and  the  incapability  of  genius  to  continue  its  own  dis- 
tinctions. Schumann  suffered  from  recurrent  melan- 
cholia. .  .  .  Wagner,  wild  and  erratic  in  youth,  in  later 
years  exhibited  a  violent  temperament,  and  often  lost 
control  of  himself.  He  had  a  mania  for  silks  and  satins, 
with  which  he  always  dressed  himself  to  compose  music. 
When  travelling  he  also  carried  these  to  decorate  his 
rooms,  and  when  he  died  he  requested  that  his  room  should 
be  upholstered  in  pink  and  pale  blue  satin.  Schubert  was 
worn  out  and  died  at  thirty-one.  Beethoven  .  .  .  was 
always  changing  his  rooms  and  was  paying  for  three  or 
four  different  lodgings  at  the  same  time.  He  seems  to 
have  alienated  his  best  friends  through  suspicious  jealousy 
and  false  accusations."^ 

The  ex-Kaiser  offers  an  interesting  study  of  a  tem- 
perament which  illustrates  the  controlled  nervous  type 
admixed  with  callousness  and  influenced  by  the  unique 
position  in  which  he  has  found  himself  as  undisputed 
arbiter  of  millions  of  intelligent  people.     Allowed  free 

1  Sir  Robert  Armstrong-Jones,  M.D.,  Temperaments  :  Is  there  a 
Neurotic  One  ?    Cf.  The  Lancet,  July  1st,  1911. 


NERVOUS  TEMPERAMENT  49 

rein,  the  general  tendency  of  the  over-sensitive  mind 
is  to  become  more  and  more  centred  on  self,  the  extreme 
case  being  that  of  the  deeply  depressed  person  who  has 
given  up  the  struggle  against  overwhelming  sensations 
of  distress  that  have  culminated  in  a  grand  depression. 
Having  reached  this  melp.ncholic  level  the  sufferer  then 
sees  everything  through  the  fog  of  the  morbid  atmo- 
sphere that  surrounds  him,  and  refuses  to  be  comforted.  It 
is  often  enough  a  hard  task  getting  people  to  fight  their 
way  through  such  negative  phases.  Particularly  physi- 
cal disorders  have  in  the  first  place  destroyed  mental 
comfort  through  their  reverberations  in  the  chambers  of 
the  brain.  But  the  egoism  of  neuroticism  by  no  means 
always  finds  expression  in  depression.  The  self-centring 
may  focus  round  an  idea  or  group  of  ideas  that  dominates 
the  field  of  thought.  In  the  fanatic  and  the  devotee  we 
only  too  often  find  the  results  of  over-centring  of  this 
kind.  An  obsession  may  be  a  nuisance,  but  an  obsession 
that  so  possesses  its  victim  that  he  or  she  feels  an  irre- 
sistible urge  to  play  a  special  part  may  become  a  source 
of  danger  to  society. 

However,  there  are  many  medium  expressions  of 
egocentricity  which  lead  to  harmless  enough  happenings 
however  troublesome  they  may  be  to  a  man's  friends. 
The  crank  is  commonly  an  innocuous  illustration  of  the 
nervous  temperament  morbidly  developing  in  the  brain 
an  obsessing  idea.  The  founders  of  a  thousand  and  one 
"  isms,"  political  systems  and  creeds  have  also  been 
illustrations  of  this  trend.  Where  the  highly-strung 
individual  is  also  ambitious,  powerful  and  unchecked 
megalomania — that  is  "  sweUed-head  "  carried  to  its 
highest  power — may  result.  Of  the  Prussian  despot  we 
have  for  years  been  told  of  his  ceaseless  activities  ;  his 
constant  tension  and  frequent  explosions  ;  of  his  sudden 
plans,  his  goings  out  and  his  comings  in  ;  aU  carried  out 
against  a  background  of  fixed  behef  in  his  divine  authority* 
Some  fifteen  years  ago  a  psychologist  of  repute  in  the 


50  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

English-speaking  world  expressed  the  considered  opinion 
that  this  exponent  of  the  divine  right  of  kings  was  so  far 
neuropathic  as  to  be  on  the  borderland  between  sanity 
and  insanity.  Long  ago  one  of  his  own  subjects  found 
him  not  unlike  a  notorious  and  cruelly  unstable  Roman 
Emperor.  The  first  mentioned  observer  declared  that 
"  his  childhood  and  youth  were  characterized  by  pecu- 
liarities of  conduct  that  may  safely  be  said  to  be  psycho- 
pathic, while  his  early  manhood  was  punctuated  with 
frequent  instances  of  decidedly  insane  behaviour."  ^ 
Quoting  this  in  recent  times,  a  leading  medical  journal 
remarked  of  the  Kaiser  that  "  there  is  enough  in  his 
megalomaniac  proclamations  about  his  destructive 
sword,  and  his  alliance  with  the  old  God  of  the  Prussians, 
to  justify  us  in  pronouncing  him  a  man  of  abnormal 
mind."  ^  More  recently  we  have  had  the  testimony  of 
Mr.  Davis,  the  Kaiser's  dentist  for  fourteen  years,  that 
in  his  imperial  patient  he  found  "  a  man  of  unparalleled 
egotism,  of  wide  reading  "  ;  yet  one  who  "  was  im- 
patient of  correction  and  who  would  brook  no  opposi- 
tion," 2  a  man  who  hid  the  egoism  of  the  abnormally 
self-centred,  and  the  obsessions  of  the  fanatic,  behind  a 
mask  of  courtesy,  affability  and  gentleness.  Clearly  this 
is  a  graphic  picture  of  the  nervous  temperament  in  one 
of  its  worst  developments. 

^  Dr.  McLane  Hamilton,  quoted  by  The  British  Medical  Journal, 
August  28th,  1915. 

'^  Arthiir  N.  Davis,  The  Kaiser  as  I  Kneiv  Him  for  Fourteen  Years.  Cf.- 
The  Times,  August  24th,  1918. 


CHAPTER  IV 

SOME  FACTORS  DETERMINING  BREAKDOWN 

Stresses  of  daily  life — Work  and  worry — Common  anxieties — House- 
hold worries — The  worrying  habit — Nerve  weakness  and  a  burdened 
mind — Nerves  and  domesticities— Strain  of  development. 

HAVING  considered  the  relations  between  the  emo- 
tions and  nervous  breakdown  in  general  terms 
it  is  desirable  to  apply  our  observations  to  everyday  Hfe. 
Granted  that  in  anyone  emotional  storms  react  hardly 
on  the  brain,  and  that  in  those  of  nervous  temperament 
the  whole  system  is  constantly  vibrating  violently  in 
response  to  waves  of  feeUng,  we  still  want  to  know  just  in 
what  particular  directions  the  conditions  of  daily  life 
favour  the  occurrence  of  these  stresses.  After  aU,  few  of 
us  live  for  long  on  high  levels  of  feeling  ;  even  those 
excitable  folk  who  are  continually  running  up  emotional 
ladders  come  down  to  ordinary  levels  for  the  routine 
business  of  life.  Consequently,  we  shaU  expect  to  find — 
and  shall,  indeed,  do  so — ^that  although  the  grand  passions 
tear  people's  nerves  to  shreds  often  enough,  in  the  great 
majority  of  cases  the  emotional  factor  operates  in  a  more 
insidious  way.  Love,  hate,  anger  and  disappointment, 
as  many  other  emotions,  wreck  the  brain  when  felt 
strongly  and  deeply — ^particularly  if  there  are  successive 
waves  of  heightened  feeling  at  short  intervals — but  for 
the  most  part  it  is  the  insidious  reactions  of  smouldering 
fires,  of  gnawing  envy,  bitter  jealousy,  long-nursed 
grievance,  unrequited  affection  and  their  fellows  that 
wreck  most  nervous  systems.    Certainly  it  is  the  mental 

51 


52  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

strain  of  these  things  rather  than  physical  stress  that 
finally  and  in  favourable  soil  determines  most  break- 
downs. In  practical  life,  indeed,  it  means,  as  abeady 
noted,  that  it  is  worry  rather  than  work,  that  is  responsible 
for  the  tired  faces  one  sees  so  commonly  about  us.  A 
man's  brain  can  stand  a  remarkable  amount  of  work 
without  becoming  over-strained,  but  as  soon  as  worry  is 
added  to  work  nerves  begin  to  fail.  Life  is  such  that 
many  people  who  have  to  work  hard  find  it  necessary 
to  worry  at  the  same  time  ;  a  temperamental  predis- 
position to  worry  leading  astray  some  who  even  from 
the  most  material  standpoint  have  nothing  to  be  anxious 
about.  We  live  in  a  time  when  few  are  content  to  leave 
off  in  more  or  less  the  same  way  as  they  began.  Few  are 
satisfied  with  their  positions.  Many  who  would  be  better 
off  if  content  with  a  moderate  success,  strive  and  struggle 
against  odds  to  gain  worldly  advance  which  can  never 
be  theirs.  In  business  circles  the  pressure  of  competition 
leads  many  men  to  worry  day  after  day  and  year  after 
year,  with  the  consequence  that  their  capacity  for  work 
is  impaired,  whereas  if  each  had  only  to  do  his  work  in 
the  certainty  that  it  would  bring  him  a  moderate  living 
and  a  comfortable  reward,  he  would  quite  easUy  be  able 
to  carry  it  on  many  more  hours  a  day  than  he  is  able  to 
do  when  worry  is  added. 

The  stimulus  of  brain-work  is  good  for  the  nervous 
system,  and  the  harder  a  man  uses  his  brain  up  to  a  cer- 
tain point  the  better  wiU  it  respond.  But  worry  soon  tires. 
Thoughts  that  race  backwards  and  forwards  through 
the  head,  thoughts  that  will  not  be  dismissed ;  the 
uncertainties  of  position,  employment,  and  so  forth,  wear 
out  the  brain  of  many  a  man  who  could  do  most  excellent 
work  if  his  bare  living  were  certainly  and  always  secured 
to  him.  Many  a  man  living  in  circumstances  suggesting 
prosperity  is  made  ill  through  the  canker  of  worry  gnaw- 
ing at  his  nervous  system  ;  not  through  overwork,  as 
his  friends  suppose,  but  through  the  anxieties  attendant 


SOME  FACTORS  DETERMINING  BREAKDOWN    53 

upon  a  self-enforced  maintenance  of  his  household  in  a 
luxurious  position.  It  is  the  man  whose  expenses  are 
large,  and  whose  income  is  large,  and  whose  interests  are 
large,  who  is  often  beset  with  fatiguing  anxieties  which 
leave  untouched  the  man  of  smaU  interests  and  certain 
income.  The  constant  strain  on  people  born  in  moderate 
circumstances  of  keeping  up  appearances  beyond  their 
position  has  carried  worry  and  ill-health  into  many  a 
household.  Financial  adventm^es  bring  much  worry. 
Gambling  in  stocks  and  shares,  rubber  booms,  oil  specu- 
lations, gold  mines,  and  similar  ventures  have  been,  and 
may  be  again,  responsible  for  a  good  deal  of  nervous 
disorder.  Financial  speculation  cannot  be  carried  on 
without  strain  ;  and  the  anxieties  born  of  gambling  have 
worn  out  many. 

Again,  there  are  persons  in  important  administrative 
posts,  won  by  their  own  determination  and  energy,  who, 
jQlHng  positions  of  authority  in  which  great  strength  of 
mind  is  required  to  deal  adequately  with  the  duties  pre- 
sented to  them,  not  infrequently  find  themselves  in- 
herently incapable  of  assuming  the  bm-den  thus  thrust 
upon  them.  To  some  a  position  of  great  responsibility 
brings  with  it  terrors  of  uncertainty  and  doubt.  Uncer- 
tainties as  to  course  of  action,  as  to  attitude  to  subor- 
dinates, as  to  confidence  in  servants,  or  as  to  the  results 
of  action,  gradually  undermine  their  nerve.  Sometimes 
we  are  sm^prised  to  hear  of  an  important  post  being  given 
up  not  long  after  it  has  been  hardly  won  by  a  keen  worker. 
Only  the  victim  and  intimate  friends  know  the  story  of 
how  the  final  ruin  of  ambition  has  depended  on  nerve 
failure  in  face  of  unaccustomed  responsibility.  House- 
hold worries  often  determine  nervous  breakdown.  Some 
women  are  so  temperamentally  constituted  that  they 
cannot  run  a  large  household  without  suffering  stress  ; 
others  through  want  of  method  bring  needless  anxieties 
on  themselves.  Many  through  no  fault  of  their  own  are 
unable  to   support  the   burden  of   those   difficulties   of 


54  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

service  which  have  been  prominent  of  late  years.  Here, 
also,  we  must  consider  incompatibility  of  marriage  ; 
incompatibility  of  friendship  ;  ill-chosen  companion- 
ships ;  and  the  unfortunate  congregation  in  families  of 
persons  who  are  absolutely  unsuited  to  live  together. 

Sometimes,  of  course,  people  worry  because  they  have 
no  interesting  occupation  ;  others  worry  over  imaginary 
grievances  between  themselves  and  their  neighbours  ; 
yet  others  worry  because  they  cannot  get  enough  amuse- 
ment, and  after  a  certain  age  tend  to  worry  about  every- 
thing they  possibly  can.  Such  persons  are  tempera- 
mentally predisposed  to  worry.  Seme  worry  themselves 
into  a  state  of  hypochondriasis,  in  which  they  are  con- 
tinually thinking  of  some  illness  or  other  ;  their  worry- 
ing, becoming  concentrated  upon  health,  turns  them  into 
confirmed  valetudinarians.  It  is  then  very  difficult  to 
distract  their  attention  from  their  bodily  troubles.  One 
meets  people  who  have  been  for  years  worrying  about 
trifles,  small  domestic  affairs,  little  business  transactions, 
even  about  their  hoHdays,  who  eventually  concentrate 
their  worrying  minds  upon  their  health  in  this  way.  Some 
seem  to  spend  the  greater  part  of  their  lives  in  going  from 
doctor  to  doctor  about  little  aches  and  pains,  small 
symptoms  of  one  kind  or  another,  which  should  never 
be  noticed  at  all  by  healthy  individuals.  When  influenza 
is  rife  they  worry  lest  the  infection  catch  them  ;  when 
gout  is  popular  they  worry  about  their  supposed  gouti- 
ness ;  when  insanity  is  talked  about,  they  worry  as  to  the 
state  of  their  own  brains.  A  goodly  number  finally  and 
persistently  concentrate  attention  on  their  stomachs. 
Hundreds  go  about  seeking  relief  from  stomachic  troubles 
which,  if  present  at  all,  they  owe  entirely  to  their  own 
morbid  habits  of  mind,  and  for  which  the  sole  hope  of 
cure  lies  in  an  elevation  of  general  health  and  nerve- 
tone.  These  people  make  difficult  patients,  and  it  requires 
a  good  deal  of  moral  force  and  self-confidence  to  stir 
them  up  sufficiently  to  break  the  morbid  habits  of  mind 


SOME  FACTORS  DETERMINING  BREAKDOWN    55 

and  body  upon  which  depend  their  chronic  ill-health. 
In  fact  they  are  self-hypnotized. 

A  man's  nerves  often  reflect  the  state  of  his  conscience. 
The  knowledge  of  having  deliberately  done  wrong  can 
only  be  a  heavy  burden  ;  a  load  that  may  be  too  heavy 
to  be  borne  even  by  the  strongest.  Secret  misdeeds 
bring  their  own  punishment.  Remorse  is  a  cbeadful 
penalty  and  bears  hardly  on  human  nerve,  which  not 
unseldom  gives  way  beneath  the  strain.  Yet  again  there 
is  such  a  thing  as  morbid  conscientiousness.  In  this  state 
of  mind  people  suffer  tortures  in  theu'  vain  regret  for 
some  trifhng  action  which  has  really  no  importance  ; 
they  magnify  molehills  into  mountains  and  needlessly 
torment  themselves  about  smaU  personal  and  domestic 
happenings  to  which  the  healthy-minded  man  would 
give  no  thought.  Wrongdoers  sometimes  sm'render 
themselves  to  the  police  rather  than  go  on  suffering  the 
strain  of  unconfessed  misdeeds.  The  victim  of  a  bur- 
dened conscience  is  well-advised  to  get  rid  of  his  load  as 
soon  as  possible,  pouring  out  his  trouble  into  sympa- 
thetic ears.  That  way  relief  comes,  and  the  explosion  of 
too-long  restrained  emotion  is  obviated.  A  classic 
example  of  the  morbid  conscience  is  the  figure  so  power- 
fully portrayed  by  Borrow  as  the  man  who  had  sinned 
against  the  Holy  Ghost. 

Hatred,  envy,  or  mahce  secretly  nursed  against  others 
invariably  react  on  those  who  encourage  these  bitter 
thoughts.  They  act  like  a  poison  upon  the  system,  and 
are  responsible  for  many  disturbances  of  health.  The 
mind  that  nm^ses  a  secret  hatred  against  somebody  else 
is  bound  to  suffer  from  the  recoil  of  the  cruel  thoughts 
it  formulates  ;  and  the  neurasthenia  of  the  bitter  thinker 
is  by  no  means  uncommon.  Little  malicious  thoughts, 
small  subterfuges,  trivial  advantages  gained  over  some 
trusting  comrade  are,  indeed,  despicable  ;  but  there  are 
few  human  beings  who  are  entirely  blameless  in  these 
things,  which  are  the  measure  of  how  far  we  are  from  the 


56  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

realization  of  man  the  image  of  God.  Still,  lamentable 
as  are  these  signs  of  our  bondage  to  false  beliefs  they  are 
far  from  crimes  and  the  healthy  minded — the  right- 
thinkers — should  use  them  as  sign-posts  pointing  the  way 
to  a  better  sense  of  life  and  living.  The  morbid  con- 
science takes  those  peccadilloes  too  seriously  and  leads 
the  neurasthenic  to  become  imbued  by  the  terrible 
thoughts  of  deadly  sin.  More  than  that,  the  thing  often 
grows  morbid,  the  obsessed  victim  believes  he  has  com- 
mitted an  unpardonable  sin,  that  there  is  no  hope  for 
him  in  this  world  or  the  next.  Lucky  are  those  who  are 
pulled  up  by  a  friendly  warning  ere  they  have  descended 
the  hill  to  the  pit  of  black  depression  waiting  for  them 
at  the  bottom.  Free  discussion  of  the  mental  difficulty 
is  their  best  hope  of  relief,  but  it  must  be  discussion  with 
some  one  who  is  not  unaccustomed  to  deal  with  these 
matters.  The  morbid  outlook  on  life  may  be  quickly 
changed  from  misery  to  brightness  when  the  situation 
is  properly  explained  to  them.  In  states  of  lowered 
nerve -tone  domestic  or  financial  troubles  which  are 
really  not  very  important  may  seem  big  and  overwhelm- 
ing, but  they  commonly  lose  their  terror  when  discussed 
with  a  true  friend.  Issues  fearfully  avoided  frequently 
appear  small  when  braved,  or  confronted  in  company 
with  a  helping  confidant — ^the  biggest  bogey  vanishes 
when  we  face  it  bravely.  When  a  staunch  friend  stands 
by  difficulties  are  never  so  appalling. 

Sensitive  nerves  figure  more  prominently  than  is 
generally  reahzed  in  the  ordinary  relations  of  family  life. 
The  story  of  the  petty  squabbles  and  jealousies  which 
mar  the  life  of  many  families  is  a  very  sad  one.  As  a 
matter  of  fact,  many  of  the  little  family  upsets  which 
are  treated  so  seriously,  and  which  often  lead  to  serious 
breaches  of  harmony,  are  due  to  a  nervous  state — 
over-sensitiveness.  Homes  are  broken  up,  and  the 
happiness  of  domestic  life  is  marred  through  indi- 
vidual reactions  which  are  misapprehended.      In  large 


SOME  FACTORS  DETERMINING  BREAKDOWN    57 

families  there  is  often  some  one  who  is  particularly 
high-strung,  and  it  is  this  unfortunate  individual  who 
somehow  or  other  becomes  the  focus  of  discord.  Given  a 
suitable  setting  inflammable  material  may  lead  to  a 
domestic  explosion.  Storms  of  this  kind  are  character- 
ized by  increasing  waves  which  ultimately  reach  a  certain 
height  and  then  decrease,  in  much  the  same  way  as  a 
tempest  at  sea.  Furious  distm'bances  are  often  recog- 
nized because  they  place  the  patient  in  a  serious  posi- 
tion ;  but  little  nerve-storms,  not  understood  as  such, 
produce  many  jars  and  quarrels  in  home  life  and  between 
friends. 

Nervous  irritabihty  is  responsible  for  many  of  the 
squabbles  which  disturb  domestic  peace.  Bad  temper  in 
many  cases  really  represents  an  iUness  ;  often  it  is  a 
troublesome  psychological  disorder.  Sulkiness,  abrupt- 
ness of  manner,  and  sudden  rudeness  often  belong  also 
to  the  same  category.  If  this  were  more  generally  under- 
stood, people  would  be  more  inclined  to  settle  their 
differences  amicably.  Home  quarrels  are  often  a  tragic 
consequence  of  wrong-thinking.  It  may  be  said  that  as 
a  matter  of  fact  serious  squabbles  and  quarrels  and  dis- 
agreements between  friends  are  not  really  very  common 
in  comparison  v/ith  the  opportunities  for  their  occur- 
rences, but  any  doctor  who  has  opportunities  of  con- 
stantly observing  the  home -life  of  weU-to-do  people, 
and,  in  fact,  the  home -life  of  all  classes  above  the  ex- 
tremely poor,  knows  that  home  quarrels  are  remarkably 
common.  There  is  little  doubt  that  many  of  these 
quarrels  depend  upon  the  morbid  irritability,  the  ex- 
cessive tension,  the  unhealthy  excitability  in  some  one's 
nervous  system  which,  under  stress  of  circumstances, 
has  resulted  in  a  little  brain-storm,  expressing  itself  as  an 
attack  of  bad  temper  which  has  been  misunderstood  and 
has  led  to  most  unfortunate  consequences.  There  are 
thousands  of  cases  which  are  now  dealt  with  in  the  public 
courts  the  proper  place  for  which  is  the  consulting-room 


58  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

of  the  specialist.  There  are  hundreds  of  instances  in 
which  separations  and  divorces  are  sought  on  the  ground 
of  incompatibility  of  temper,  or  similar  circumstances,  in 
which  the  right  course  of  action  would  have  been  for  the 
parties  concerned  to  consult  a  doctor  before  resorting  to 
drastic  measures.  Why  should  not  an  irritable  husband 
or  a  nagging  wife  take  such  a  reasonable  step,  before  seek- 
ing legal  advice  which  may  lead  to  irreparable  misery 
and  disaster  for  them  both  ? 

Matters  of  sex  are  often  determining  factors  in  pro- 
ducing nervous  unrest  or  breakdown,  but  there  is  a  ten- 
dency to-day  to  take  extreme  views  of  the  relations 
between  these  and  nervous  disorders.  Certainly  many 
seek  rehef  from  nerve  symptoms  who  have  at  some  time 
or  other  been  bothered  with  primary  sex  emotions,  but 
human  nature  being  what  it  is  the  same  might  be  said  of 
any  other  kind  of  malady.  Still,  the  effects  of  strain 
inseparable  from  unfortunate  love  affah's,  from  jealousy, 
from  loss  of  husband  or  wife,  are  always  incalculable 
and  often  far-reaching  in  their  consequences.  It  is  not 
surprising  that  where  health  is  impaired  from  such  causes 
the  nervous  system  should  bear  the  brunt  of  the  dis- 
turbance ;  and  often  enough  one  can  trace  the  effects 
of  some  amatory  crisis  in  originating  a  serious  condition. 
Any  consideration  of  this  factor  of  causation  touches  that 
great  problem  of  the  unmarried  which  concerns  a  lament- 
able number  of  women  who  are  prevented  from  entering 
the  state  of  matrimony.  The  crux  of  this  problem  can- 
not be  put  into  better  words  than  those  of  the  late  Sir 
Thomas  Clouston,  M.D.,  who  wi'ote  :  "  Intense  and 
complete  outward  repression  and  inhibition  of  certain 
physiological  cravings  required  by  our  morals  and  civiliza- 
tion causes,  no  doubt,  a  dangerous  strain  on  the  brain 
functions,  and  a  reaction  in  other  dnections  where  there 
is  hereditary  neurotic  weakness." 

Then,  again,  the  special  period  of  development  of  the 
reproductive  functions  throws  a  tremendous  strain  on 


SOME  FACTORS  DETERMINING  BREAKDOWN    59 

the  system  during  the  years  of  puberty  and  adolescence. 
Hence  so  many  neuroses  develop  in  girls  who  are  budding 
into  womanhood.  In  this  also  can  be  found  ^he  reason  why 
for  young  men  the  ten  years  from  fifteen  to  twenty-five 
are  so  productive  of  neurasthenic  ailments.  This  is  the 
time  when  the  boisterous  mamier  of  the  boy  gives 
way  to  a  more  dreamy  attitude  of  mind,  when  young 
women  are  no  longer  regarded  just  as  gentle  com- 
panions, but  are  viewed  in  a  somewhat  mystical  light  ; 
when  poetry  becomes  of  some  interest  ;  and  when, 
with  strange  pulses  beginning  to  beat  within  him,  the 
youth's  soul  awakens  to  the  full  reality  of  life  and 
life's  work.  To  many  this  is  a  time  of  ever-increasing 
joy  in  the  knowledge  of  growing  manhood  ;  to  the  deli- 
cate the  changes  going  on  within  the  organism  may 
prove  too  much  for  the  nervous  system.  It  is  thus  under- 
standable why  neurasthenic  ailments  are  so  common 
amongst  students  and  others  who  have  to  do  a  great  deal 
of  brain- work  during  the  period  of  development.  The 
natural  way  of  spending  adolescence  is  out  of  doors  in 
occupations  that  will  not  throw  any  strain  on  the  nervous 
system.  The  student  lives  too  much  indoors  and  thinks 
too  much,  often  paying  dearly  for  his  temerity  in  out- 
raging Nature's  laws.  Herein  partly  lies  the  explanation 
of  the  paradox  that  many  of  those  who  acquit  themselves 
brilliantly  as  students  have  but  moderate  success  in 
after-life.  Exhausting  their  nervous  systems  at  a  critical 
time,  they  are  unable  to  make  up  for  their  spendthrift 
output  of  nervous  energy. 


CHAPTER  V 

CONDITIOXS   PREDISPOSING  TO   BREAKDOWN 

{A)  Occupation,  Climate  and  Constitution 

Predisposing  as  opposed  to  determining  causes — The  prevalence  of 
breakdown  among  brain  workers — Influence  of  occupation — Strain 
of  modem  conditions — Motoring — Telephone  work — Occupational 
breakdown  in  America — Climate  and  neurasthenia — Debilitated 
effects  of  residence  in  Tropical  countries — Heredity — Ancestral 
indiscretions — Marriage  and  consanguinity — Depleted  stocks. 

THE  circumstances  of  daily  life  referred  to  in  the 
preceding  chapter  as  often  determining  the  onset 
of  signs  of  nerve  disorder  are,  of  course,  frequently  modi- 
fied by  conditions  partly  or  wholly  operating  on  the 
physical  side.  It  will  be  convenient  now  to  consider  these, 
which  for  purposes  of  classification  may  be  regarded  as 
predisposing  rather  than  determining  factors.  On  occa- 
sion it  is  difficult,  indeed,  to  say  which  happenings  have 
predisposed  as  distinct  from  those  which  have  actually 
determined  a  breakdown.  Where  the  event  follows  the 
working  of  a  combination  of  many  possible  causes  the  dis- 
tinction perhaps  cannot  be  made.  But  for  present  pur- 
poses, and  with  these  reservations,  the  grouping  here  made 
can  well  stand  as  being  convenient.  Occupation,  climate, 
heredity,  nerve-poisons,  wasting  diseases  and  accidents  are 
some  of  the  things  predisposing  to  nervous  trouble  which 
we  can  now  proceed  to  study.  As  might  be  expected,  nerv- 
ous maladies  are  prevalent  among  brain  workers  ;  but  it 
must  not  be  supposed  that  it  is  especially  predisposed  to  by 
the  work  of  journahsts,  barristers  or  doctors  for  example. 
On  the  contrarj^  the  reason  why  the  vast  army  of  neuras- 
thenics is  so  constantly  recruited  from  the  professions  is 

60 


CONDITIONS  PREDISPOSING  TO  BREAKDOWN    61 

because  many  who  foUow  them  are  of  nervous  tempera- 
ment from  the  outset.  People  of  the  nervous  type,  rather 
highly-strung,  and  quick  in  thought  often  find  their 
natural  bent  in  a  professional  career  rather  than  in  any- 
thing wherein  they  would  have  to  display  more  physical 
than  mental  activity.  But  wherever  there  is  a  predis- 
position to  neurosis  mental  strain  is  necessarily  liable  to 
bring  out  latent  tendencies  to  neurasthenic  conditions. 
The  great  orator,  the  tragedian,  the  fluent  advocate,  the 
priest  or  missionary  consumed  with  spiritual  fire  are 
types  of  those  whose  occupations  predispose  to  collapse. 

On  the  other  hand,  however,  there  is  a  good  deal  of 
nerve-disorder  amongst  those  who  never  do  much 
hard  work  at  the  best  of  times.  It  is  a  fact  that  lack 
of  occupation  is  often  responsible  for  nerve-symptoms  in 
people  who  have  no  definite  object  in  life,  and  are  very 
often  bored  to  distraction  with  the  mere  effort  of  seeking 
fresh  amusements.  Persons  of  this  kind  are  readily 
relieved  of  their  troubles  by  being  made  to  take  up  some 
serious  occupation.  In  such  cases  a  hobby  is  not  usually 
sufficient  to  bring  about  the  mental  change  required  ; 
it  is  absorption  in  some  useful  pursuit  which  is  so  bene- 
ficial. Far  more  serious  are  the  cases  of  breakdown  which 
one  finds  in  elderly  men  who  have  retired  or  been  retired 
from  their  occupations  ;  men  who  are  strong  mentally 
and  physically,  but  have  to  retire  from  some  responsible 
position  because  they  have  reached  the  age  at  which 
officialdom  considers  it  necessary  to  consign  them  to  the 
shelf.  The  effect  of  sudden  cessation  of  work  and  mental 
activity  in  such  instances  is  to  throw  a  remarkably 
severe  strain  on  the  nervous  system,  and,  out- 
side absorbing  distractions  having  gone,  the  indi- 
vidual tends  to  become  introspective  and  nervous. 
Further,  a  mind  unused  not  infrequently  becomes 
quickly  disordered,  and  the  corresponding  loss  of 
nerve-tone  is  not  uncommonly  reflected  in  physical 
infirmity.     Not  only  is  such  an  unfortunate  strain  of 


62  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

circumstances  seen  in  the  case  of  retired  officials,  but 
there  are  not  a  few  instances,  which  many  can  recall,  in 
which  the  successful  business  man  has  decided  to  retire 
under  his  prosperity,  and  having  done  so  quickly  breaks 
down  through  sheer  brain  inaction. 

This  question  of  occupation,  or  rather  lack  of  occupa- 
tion in  retired  people  is  a  very  difficult  one.  It  is  not 
always  easy  to  replace  the  absorbing  interests  of  a  life- 
long career,  indeed,  of  a  lifework  itself,  by  some  satis- 
fying substitute.  It  is  aU  very  well  to  tell  a  man  who  has 
governed  half  a  continent  to  play  golf  and  to  read  novels, 
or  to  write  to  the  papers  or  to  take  up  gardening,  or  to 
fill  up  his  time  in  a  hundred  other  trivial  ways,  but  he 
may  not  be  able  to  throw  the  same  energies  and  interest 
into  growing  roses  as  he  did  into  governing  a  colony. 
One  may  set  a  man  who  has  achieved  success  in  the  con- 
duct of  a  commercial  undertaking  to  coUect  stamps  in 
the  days  of  his  retirement,  but  he  may  be  quite  unable  to 
occupy  himself  properly  in  any  such  direction.  StUl 
one  has  to  make  the  best  of  things,  and  there  are  many 
useful  occupations  which  can  be  suggested.  Anyone 
who  is  contemplating  retnement  after  a  busy  and  active 
career  should  seriously  consider  how  time  is  to  be  occu- 
pied when  the  change  has  been  made,  and  not  wait  until 
arrives  the  deadly  depression  arising  from  the  feeling 
that  there  is  nothing  to  do,  that  he  is  no  longer  an 
important  link  in  the  chain  of  active  existence. 

Certainly  it  is  the  intellectuals  who  suffer  mostly  from 
nerve  troubles  at  the  present  day,  but  quite  commonly 
such  ailments  occur  amongst  uneducated  manual  workers. 
Artisans,  labourers,  porters,  women  who  probably  never 
open  a  book  or  write  a  line,  domestic  servants  and  navvies, 
are  by  no  means  free  from  such  affections,  and  some 
very  severe  cases  occur  amongst  them  ;  thus  showing 
that  monotony  of  life,  poor  circumstances,  and  the  in- 
numerable worries  associated  therewith,  are  just  as 
potent  to  cause  nervous  disorder  in  the  less-favoured 


CONDITIONS  PREDISPOSING  TO  BREAKDOWN    63 

ranks  of  society  as  amongst  those  who  are  better  off. 
Obviously,  such  factors  as  alcoholism,  shock  from  acci- 
dents, exhausting  diseases,  grief,  and  disappointment 
are  just  as  likely  to  occur  amongst  the  poor  as  amongst 
the  rich. 

During  the  last  ten  years  or  so  a  new  occupational 
factor  in  the  production  of  nervous  disorders  has  become 
prominent,  namely,  the  effect  of  modern  methods  of 
locomotion.  Thus,  the  control  of  motor-vehicles  often 
throws  great  strain  on  the  nervous  system,  severe  re- 
actions occurring  particularly  where  there  is  predisposi- 
tion to  nervous  instability.  Especially  is  this  important 
for  those  who  have  to  drive  motor  vehicles  through 
crowded  traffic.  Chauffem^s  driving  taxi-cabs  tell  one 
that  their  capacity  for  work  is  not  unseldom  seriously 
limited  by  the  effects  of  nerve-strain.  Some  time 
ago  a  taxi-driver  pointed  out  that  his  wage-earning 
possibiHties  were  always  limited  by  the  fact  that  after 
a  certain  number  of  hours — far  short  of  the  number  he 
might  have  been  expected  to  work — he  found  it  abso- 
lutely necessary  to  take  his  cab  back  to  the  garage  owing 
to  the  nervous  feeling  which  bothered  him  when  tired. 

Habitual  motoring  in  a  big  city  is  bound  to  be 
attended  by  a  certain  number  of  accidents  of  varying 
degree.  For  every  one  person  who  is  seriously  injured 
by  motors  in  the  streets  there  are  a  considerable  number 
who  are  knocked  down  and  escape  with  very  little  hurt. 
But  the  effect  and  the  shock  to  the  chauffeur  in  all  these 
cases  must  be  very  much  the  same.  One  can  often  see 
the  painful  signs  of  great  shock  in  the  pallid  face  of  some 
chauffeur  who  has  been  unfortunate  enough  to  run 
into  something  and  who  has  subsequently  had  to 
stand  by  while  an  account  of  the  case  was  jotted  down 
by  a  police  official.  Such  jars  leave  a  permanent  mark 
on  the  nervous  system.  Many  accidents  are  due  to 
hesitation  on  the  part  of  drivers  whose  co-ordinating 
faculties  are  paralysed  by  an  accumulated  nerve-strain 


64  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

and  the  sudden  necessity  for  quick  decision.  Among 
amateurs  it  is  not  at  all  rare  to  find  people  who  from  this 
cause  have  had  to  give  up  driving.  One  often  finds  that 
even  one  sHght  accident  or  "  close  shave  "  is  quite  suffi- 
cient to  upset  nerves  seriously.  Hence  we  should  extend 
a  little  more  thought  and  sympathy  to  the  professional 
driver,  who  has  to  continue  his  arduous  occupation, 
however  much  his  nerves  may  have  been  jangled 
by  his  adventures.  It  is  a  question  whether  some  system 
of  health  inspection  of  public  chauffeurs,  especially 
directed  to  the  matter  of  nerve,  will  not  ultimately  have 
to  be  carried  out.  Efficient  treatment  and  rest  wiU  do 
much  to  remedy  any  nervousness  that  may  handi- 
cap a  chauffeur,  provided  his  weakness  is  taken  in 
time.  It  is  no  good  letting  a  man's  nervous  system  go  all 
to  pieces  before  taking  any  notice  of  him,  and  then  find  it 
necessary  to  tell  him  that  he  must  give  up  his  job.  A  little 
forethought  may  preserve  him  in  capable  health.  Much 
the  same  might  be  said  about  railway  workers.  Careful 
investigation  has  proved  beyond  doubt  that  some  of  the 
worst  accidents  have  not  been  due  to  panic  or  loss  of 
nerve  under  exciting  conditions,  but  to  a  temporary 
failure  of  judgment  in  ordinary  routine.  Monotony  of 
work  carried  out  day  after  day  under  the  same  conditions 
of  unrelieved  routine  may  lead  to  such  a  blunting  of 
capacity.  Indeed,  in  the  official  report  on  a  tragic  acci- 
dent that  occurred  a  few  years  ago  this  was  practically 
admitted  as  a  factor  influencing  the  want  of  judgment 
that  had  led  to  the  catastrophe. 

Again,  telephone  work  is  carried  out  under  conditions 
that  are  most  "  trying  "  to  people's  nerves.  A  telephone 
operator  is  subjected  to  a  constant  strain  of  attention, 
and  it  is  to  be  feared  that  the  stress  of  the  harassing  work 
carried  out  is  not  always  lessened  by  the  sympathy  of  the 
public.  Every  one  agrees  that  it  is  irritating  to  be  foiled 
in  one's  attempts  at  quick  communication,  especially  so 
if  after  a  long  wait  and  much  curious  stimulation  of  one's 


CONDITIONS  PREDISPOSING  TO  BREAKDOWN     65 

ear  nothing  better  than  a  "  wrong  number  "  results  ! 
Such  experiences  combine  the  nerve-strain  of  gambling 
without  its  possibly  compensating  excitements.  This 
may  be  trying  enough.  But  the  operator  is  bombarded 
by  calls  hour  after  hour,  and  passes  her  time  changing 
many  pegs  into  a  host  of  holes  whilst  having  to  preserve 
her  equanimity  through  all  the  bustle  of  the  day.  It 
is  not  to  be  wondered  at  that  some  years  ago  it  was  found 
necessary  to  institute  an  official  inquiry  into  the  preva- 
lence of  "  nerves  "  amongst  telephone  operators. 

Of  conditions  leading  to  nervous  breakdown  in  America 
we  are  told  :  "  Occupations  are  important  causative 
factors.  Those  causing  great  emotional  stress  are  most 
dangerous.  Thus,  actors,  business  promoters,  specula- 
tors (financial,  not  philosophical),  and  clergymen  of  the 
intense  type  are  especially  liable  to  breakdown.  The 
fault  is  not  altogether  with  the  work.  It  is  partly  due 
to  the  fact  that  emotionalists  are  prone  to  be  drawn 
to  it."  1 

The  relations  of  occupation  to  nervous  breakdown  are 
sometimes  influenced  by  climatic  considerations.  There 
is  no  doubt  that  local  circumstances  of  work  and  living 
quite  often  determine  the  onset  of  a  breakdown.  In  our 
own  country  the  differences  of  climate  are  not  so  marked 
as  to  be  commonly  a  potent  influence  of  this  kind  ; 
nevertheless,  one  does  from  time  to  time  find  people 
whose  nervous  predispositions  are  brought  out  in  par- 
ticular districts.  Certainly  there  are  quite  a  number  who 
seem  unable  to  live  or  work  with  comfort  in  the  bracing 
ail'  of  the  east  and  north-easterly  district  particularly 
near  the  coast.  On  the  other  hand,  there  are  some  who 
become  neurasthenic  in  the  softer  atmosphere  of  the  west 
country.  Where  local  cHmate  is  adverse  to  an  individual 
and  his  work  is  also  antagonistic  to  his  nervous  balance 
there  is  clearly  all  the  more  chance  of  incapacitating  dis- 
order occurring.  However,  whilst  not  of  primary  import- 

^  Osier's  System  of  Medicine,  Vol.  V,  pp.  620-627, 


66  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

ance  to  the  average  person  of  nervous  temperament  in  this 
country,  the  question  of  climate  is  one  of  definite  signifi- 
cance in  relation  to  existence  in  tropical  countries.  It  has 
been  said  that  all  white  men  worldng  for  years  in  hot  coun- 
tries tend  to  deterioration  of  health  ;  indeed,  it  is  recorded 
that  whole  peoples  have  become  debilitated  after  migra- 
tion to  tropical  climates.  One  thinks  of  Baber,  a  sovereign 
who  descended  upon  India  with  conquering  hosts  about 
the  time  when  Henry  VIII  reigned  in  these  islands.  It  is 
related  that  this  potentate  found  it  necessary  to  send  his 
people  home  wholesale  ;  only  in  this  way  could  he  counter- 
act the  enervating  consequences  of  their  change  of  country. 
At  this  distance  of  time  it  is  difficult  to  say  what  other 
factors  might  have  been  at  work  in  producing  this  neuras- 
thenia of  a  host,  but  there  is  further  evidence  in  the 
history  of  other  invaders  of  the  Indian  Peninsula  that  the 
conditions  of  the  plain  produced  nervous  exhaustion  in 
races  who  went  thither  as  conquerors.  Some  years  ago 
an  eminent  authority  on  the  health  conditions  of  our 
Indian  Empire  drew  attention  to  this  weakening  of 
peoples  invading  India.  He  did  so  as  an  introduction 
to  an  account  of  the  exhausting  effects  of  hot  climates 
on  the  nervous  system  of  European  officials,  stating  that  : 
"  An  officer  otherwise  in  every  way  a  good  fellow,  be- 
comes short-tempered  ;  forgets  names  ;  is  troubled  with 
sleeplessness  ;  feels  his  work  too  much  for  him  ;  shirks 
responsibility  ;  given  to  making  molehills  into  moun- 
tains ;  procrastinating  ;  susceptible  on  slight  exertion, 
mental  or  physical,  to  fatigue,  and  with  a  loss  of  con- 
centration." ^  An  excellent  description  of  the  sort  of 
malady  one  sees  time  after  time  in  men  who  come  home 
from  India  or  Africa  in  a  neurasthenic  state.  The  preva- 
lence of  such  disorders  is,  indeed,  indicated  by  the  fact 
that  typical  names  have  actually  been  given  to  it  in  differ- 
ent parts  of  the  world  ;  certainly  in  addition  to  the  well- 

1  Sir  Havelock  Charles,  M.D.,  "  Neurasthenia  Among  Europeans  in 
India  '  {British  MedicalJournal,  March  28th,  1914). 


CONDITIONS  PREDISPOSING  TO  BREAKDOWN    67 

known  "  tropical  liver  " — a  term  which  often  attributes 
to  a  much  maligned  organ,  troubles  which  are  really 
centred  in  the  nervous  system — one  has  heard  of  "  Bengal 
head,"  "  Sudan  head,"  "  Burmese  head,"  and  "  Punjab 
head."  It  may  well  be  asked,  as  suggested  by  a  leading 
medical  journal  some  time  back  in  reference  to  this  sub- 
ject, if  we  are  not  by  our  system  of  education,  and  the 
strain  of  competition,  breeding  a  race  of  a  nervously  pre- 
disposed people  who  cannot  live  under  the  conditions 
of  work  in  the  tropics.  A  graphic  description  of  nervous 
breakdown  in  Indian  heat  is  to  be  found  in  Mr.  Rudyard 
Kiplhig's  At  the  End  of  the  Passage. 

Heredity  is  often  a  vital  factor  in  predisposing  to 
nervous  breakdown,  and  we  can  now  see  how  far  an 
inherited  delicacy  causes  the  production  of  nem'asthenic 
troubles  ;  noting  at  once  that  many  suffer  in  this  way 
through  no  fault  of  their  own.  Time  after  time  it  has 
been  shown  that  nervous  disorder  is  predisposed  to  in 
certain  families,  the  history  of  which  records  instances 
of  instability  in  preceding  generations.  It  is  a  circum- 
stance that  should  not  be  ignored,  but  faced  boldly,  so 
that  by  right  education  and  due  precaution  the  worst 
threats  of  instability  may  be  brought  to  naught.  Un- 
doubtedly that  nervous  delicacy  in  one  generation 
which  so  commonly  becomes  reflected  in  the  next  has 
been  accentuated  in  our  time  by  certain  factors  in  the 
lives  of  our  ancestors.  Perhaps  the  Victorian  era  was  in 
some  respects  good  for  the  nation's  nerves,  but  at  an 
earlier  period  health  must  have  been  shattered  by  the 
habits  of  drink,  gambling  and  other  excitements  then 
rife.  We  have  to  pay  for  the  extravagances  of  our  gay 
predecessors  who  from  the  time  of  the  Restoration 
developed  the  excitements  of  life  to  their  utmost, 
and  now  know  that  past  consumption  of  strong 
Liquors  has  sown  the  seeds  of  nervous  weakness  in  our 
generation.  On  the  other  hand,  the  opinion  has  been 
expressed  that  in  those  Good  Old  Days  people  lived 


68  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

quietly  and  comfortably,  laughed  often  and  grew  fat, 
thus  stormg  energy  which  is  to  be  found  useful  in  a  more 
active  time.  Of  course,  this  may  react  in  either  of  two 
directions,  for  our  immediate  predecessors  may  have  so 
drawn  on  the  family  store  that  we  are  now  feeling  a  lack  ; 
or  it  may  be  our  irresponsibility  in  draining  present 
reserves  that  is  going  to  penalize  the  generations  to 
come.  "  One  generation  may,  by  living  at  high  pres- 
sure, and  thereby  disregarding  hygienic  laws,  exhaust 
and  use  up  more  than  its  share  of  the  ancestral  energy 
transmitted  to  it.  It  may  draw  a  bill  on  posterity  and 
not  hand  on  to  the  next  generation  enough  to  pay  it.  I 
believe  many  of  us  are  now  having  the  benefit  of  the 
calm,  lazy  lives  of  our  forefathers  of  past  generations 
who  stored  up  energy  for  us.  We,  in  this  too  strenuous 
generation,  are  using  it  up."^  At  all  events,  inherited 
weakness  of  the  tissues  composing  the  brain  is  a  highly 
important  predisposing  cause  of  all  kinds  of  nervous 
derangement  ;  nevertheless,  it  is  wrong  to  say  that 
neurasthenia  is  inherited,  because  even  a  dehcate  nerv- 
ous system  will  not  break  down  unless  some  overbearing 
strain  is  placed  upon  it.  The  strain  may  be  of  a  kind 
that  stronger  people  would  regard  as  negligible  ;  never- 
theless, it  is  stress  enough  for  the  predisposed  person. 
It  is  not  the  disease  which  is  inherited,  but  the  tendency 
to  it.  It  is  weU  that  this  should  be  fully  understood,  as 
there  is  no  more  lamentable  sight  than  that  of  the  person 
who  sits  down  crushed  under  the  weight  of  a  supposedly 
inevitable  inheritance  of  nerve  trouble.  The  man  who 
knows  of  his  inherent  nerve -weakness  should  use  that 
knowledge  to  protect  himself  against  its  becoming  an 
inconvenience  to  him.  Certainly  he  should  not  assume 
the  inevitabihty  of  a  breakdown. 

The  problem  of  heredity  touches  the  question  of 
consanguinity  as  marriage  of  closely  related  persons  fre- 
quently produces  in  their  offspring  a  dangerous  delicacy 

1  The  late  Sir  Thomas  Clouston,  M.D.,  The  Hygiene  oj  Mind,  p.  169. 


CONDITIONS  PREDISPOSING  TO  BREAKDOWN    69 

of  nerve -tissues.  Thousands  of  families  suffer  in  their 
nervous  derangement  the  penalty  of  too  strict  an  observ- 
ance of  caste,  as  witnessed  by  the  tragic  story  of  several 
famous  royal  houses.  On  the  Continent  inter-marriage 
has  brought  houses  like  that  of  Wittelsbach  to  a  tragic 
pass  of  nervous  instability,  whilst  Bismarck's  scornful 
reference  to  Austria's  idiot  archdukes  was  not  without 
point  in  the  matter  of  nervous  inheritance  due  to  con- 
sanguinity. 

Allied  to  the  factor  of  consanguinity  is  that  of  de- 
pleted stock  apparently  resulting  from  exhaustion  after 
centuries  of  activity.  As  in  animals  and  plants,  so  with 
men,  a  stock  tends  to  wear  out  in  time  unless  renewed  by 
infusion  of  fresh  energy  from  without.  The  aristocrat 
may  have  to  pay  dues  for  his  aristocracy  in  the  form 
of  neurasthenic  troubles.  Among  parental  causes  of  a 
constitutionally  weak  nervous  system,  we  find  many 
which  in  themselves  might  appear  to  be  preventable. 
Thus  the  marriage  of  two  persons  themselves  of  nervous 
temperament  is  very  likely  to  result  in  nerve-weakness 
in  the  next  generation  ;  similarly  the  marriage  of  two 
persons  whose  nervous  system  has  been  weakened  from 
various  causes  is  not  likely  to  augur  well  for  the  nervous 
stability  of  their  children.  And  this  question  as  to  the 
advisabihty  of  the  marriage  of  people  whose  nervous 
systems  are  unstable  is  one  of  the  most  important  prob- 
lems which  practical  eugenists  will  have  to  deal  with  in  the 
future.  Any  discussion  of  this  matter  must,  of  course, 
take  into  consideration  the  question  of  degree.  The 
marriage  of  two  people  either  of  whom  suffers  from 
temporary  nerve-weakness  is  obviously  of  nothing  like 
the  same  importance  as  a  marriage  where  one  of  the  con- 
tracting parties  is  afSicted  with  constitutional  failure  of 
nerve-strength,  or  where  one  of  "the  marrying  persona  is 
so  far  weakened  in  regard  to  the  nervous  system  as  to 
lose  at  times  entire  control  of  the  mental  faculties. 
Taking  the  worst  case  first,  we  know  that  an  appalhng 


70  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

amount  of  nerve-weakness  is  transmitted  from  one  genera- 
tion to  another  through  the  marriage  of  unstable 
individuals.  Yet,  although  our  duty  seems  clear  in 
regard  to  these  extreme  cases,  it  is  by  no  means  so  clear 
when  one  comes  to  consider  the  marriages  of  individuals 
who,  although  obviously  of  nervous  temperament,  or 
even  with  very  greatly  impaired  nervous  vigour,  are 
quite  able  to  take  care  of  themselves,  and  can  scarcely 
be  interfered  with  in  regard  to  such  matters.  The  mar- 
riage of  cousins  is  also  a  potent  cause  of  nervous  in- 
stability. It  is  not  uncommon  for  the  children  of  such 
marriages  to  be  subject  to  nervous  disorder  throughout 
their  lives.  Here  again  we  have  a  cause  of  the  origin  of 
a  nervous  generation  which  is  in  itself  essentially  pre- 
ventable, although  it  may  be  a  long  while  before  as  a 
nation  we  insist  upon  its  practical  prevention.  Other 
direct  causes  of  inherited  nerve-weakness  are  the  trans- 
mission of  constitutional  disorder  which  especially  affects 
the  nervous  system  ;  the  marriage  of  elderly  people  ; 
or  the  marriage  of  an  old  man  and  a  young  wife.  In  all 
these  conditions  there  are  factors  which  tend  to  under- 
mine the  nerve-force  of  the  next  generation,  and  these 
are  among  the  problems  which  eugenists  will  have  to  deal 
with  satisfactorily  before  they  can  make  much  progress 
in  their  great  work  of  benefiting  the  nation's  future 
physique. 


CHAPTER  VI 

CONDITIONS   PREDISPOSING   TO   BREAKDOWN 

(B)  Poisons,  Shocks  and  Some  Others 

Nerve  poisons — Auto-intoxication — Tea,  coffee,  alcohol  and  tobacco — ■ 
Drug  taking — Influenza — -Trench  fever — Accidents  and  injuries— 
Tratunatic  neurasthenia — Nervous  breakdown  after  operations — 
Race — Age. 

BUILT  up  as  it  is  of  the  most  delicate  tissues  of  the 
human  body  the  brain  quickly  responds  to  deleteri- 
ous matters  circulating  in  the  system,  and  many  nervous 
disorders  are  maintained  or  initiated  on  the  physical  side 
by  nerve  poisons.  Let  it  be  noted  at  once  that  these 
health-destroying  substances  are  not  always  introduced 
from  without,  but  are  frequently  manufactured  within 
ourselves  owing  to  the  breakdown  of  some  other  part 
of  the  general  machinery  of  organic  life.  At  least 
as  many  instances  of  nerve -poisoning  exemplify  the 
effects  of  self-poisoning — auto -intoxication — as  those  of 
extraneous  poisons.  Moreover,  when  nerves  fail  as  a 
result  of  serious  infective  illness,  say  influenza  or  trench 
fever,  the  injury  is  brought  about  by  the  poisons  set  free 
within  the  body  by  the  germs  of  the  respective  diseases. 
In  the  consideration  of  chronic  illness  of  any  kind,  one 
should  always  be  on  the  look  out  for  possibly  hidden 
microbes  that  may  be  persistently  poisoning  the  sick  man. 
Full  discussion  of  this,  as  of  auto-intoxication,  does  not 
come  within  the  scope  of  this  book,  suffice  it  to  say  that 
there  is  nowadays  general  agreement  that  the  stomach 
and  bowel — particularly  the  colon — are  the  sites  of 
poison  manufacture  in  many  instances. 

71 


72  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

From  without,  the  nervous  system  often  suffers  on  the 
one  hand  from  the  result  of  excess  in  consumption  of 
such  commodities  as  tea,  coffee,  alcohol,  and  on  the 
other  from  morbid  habits  of  self-drugging.  Tobacco 
also  must  not  be  overlooked  as  a  not  unknown  source  of 
nerve  poisoning.  Under  ordinary  conditions  of  health 
and  moderate  use,  tea,  coffee,  and  alcohol  are  harmless 
enough,  but,  welcome  as  they  may  be  on  our  table,  let 
us  remember  that  they  are  detrimental  to  those  whose 
nervous  systems  are  impaired  in  vitality.  Even  com- 
paratively weak  tea  or  coffee  may  produce  added  dis- 
comfort in  neurasthenic  people,  thus  showing  how  in 
ill-health  nerve  tissues  are  peculiarly  sensitive  to  their 
action.  As  with  healthy  people  the  question  of  indi- 
vidual susceptibility  comes  in  here,  so  that  in  a  few  deli- 
cate persons  tea  or  coffee  will  actually  produce  great 
excitement,  distressing  palpitation,  giddiness,  or  gastro- 
intestinal disturbance.  This  is  on  all  fours  with  the 
familiar  observation  that  there  are  people  in  the  best 
of  health  who  cannot  take  a  cup  of  tea  without  sub- 
sequent discomfort,  whilst  others  cheerfully  drink  a 
strong  brew  knowing  themselves  to  be  immune.  Signs  of 
tea  poisoning  include  disturbed  sleep,  irritability,  trembl- 
ing, indigestion,  poor  appetite,  palpitation.  In  excess  tea 
drinking  has  been  known  to  produce  a  state — tea  in- 
ebriety— which  in  some  respects  resembles  drunkenness. 
To  avoid  ill-effects  from  tea  it  should  be  made  by  pouring 
the  boiling  water  on  to  the  leaves  placed  in  a  strainer,  or  if 
made  in  a  tea-pot  the  infusion  should  be  ^Doured  off  after 
it  has  stood  not  more  than  two  or  three  minutes.  China 
tea  is  certainly  less  harmful  than  the  coarser  varieties  in 
common  use.  Where  tea  is  injurious  to  the  nerves,  coffee 
is  still  more  so.  The  active  elements  in  tea  and  coffee — 
respectively  theine  and  caffeine — may  for  all  practical 
purposes  be  considered  identical,  and  consequently  they 
resemble  each  other  in  their  effects  on  the  nervous  system. 
Tired  brain-workers  should  beware  of  resorting  to  tea  or 


CONDITIONS  PREDISPOSING  TO  BREAKDOWN    73 

coffee  to  stimulate  their  flagging  energy ;  even  should 
they  succeed  by  this  means  in  keeping  up  for  a  time  their 
out-put  of  good  work,  the  price  they  have  to  pay  is 
dangerously  high.  All  that  these  stimulants  do  is  to 
unlock  and  use  up  stores  of  nerve-energy  that  Nature  has 
accumulated  in  view  of  some  emergency.  When  these 
stores  have  been  recklessly  squandered  Nature  comes 
down  with  a  severe  punishment,  usually  in  the  form  of  a 
serious  attack  of  nervous  exhaustion. 

Much  the  same  may  be  said  of  alcohol  in  relation  to 
the  nervous  system.  Alcohol  taken  habitually  adds  to 
the  prevalence  of  neurasthenic  troubles  in  two  ways  ; 
by  sapping  the  energy  and  poisoning  the  brains  of  many 
who  generally  realize  that  they  are  taking  more  than  is 
good  for  them ;  consequently  by  emphasizing  ner- 
vous tendencies  in  constitutionally  predisposed  persons. 
Alcohol  attacks  nerve  tissues  with  special  virulence  in 
some  people,  producing  three  common  types  of  disorder 
due  to  its  deleterious  action  on  nerve-cells  and  fibres, 
namely,  true  neurasthenia  (exhaustion),  nemitis  and 
insanity.  The  last-named  results  from  the  direct  de- 
structive effect  on  the  brain-cells  which  in  chronic 
alcohohsm  gradually  degenerate  and  sometimes  lose 
their  vitality  altogether. 

Promiscuous  drug  taking  is  responsible  for  a  good  deal 
of  nervous  trouble.  Curiously  enough,  many  of  those 
whose  nerves  have  been  deranged  by  drugs  have  in  the 
first  place  resorted  to  them  for  the  relief  of  nervous 
symptoms  ;  the  craving  for  rest  or  increased  energy 
becomes  so  insistent  at  times  that  sedatives  or  stimu- 
lants are  thoughtlessly  taken.  Because  morphia  both 
soothes  and  stimulates  it  is  the  drug  that  has  claimed 
most  victims,  but  there  are  numerous  other  poisons  which 
from  their  direct  and  powerful  action  on  the  nervous 
system  secure  many  worshippers.  They  seize  readily  on 
delicate  people,  and  those  who  take  them  without  medi- 
cal advice  incur  great  danger. 


74  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

Debilitating  illness  of  a  general  kind  very  frequently 
depresses  vitality  so  much  that  the  nervous  system  gives 
way  and  convalescence  is  interrupted  and  prolonged  by 
the  onset  of  distressing  nerve  symptoms.  Among  ill- 
nesses that  have  a  special  tendency  to  produce  a  secondary 
neurasthenia,  influenza  holds  the  leading  place.  Since 
its  first  invasion  of  this  country  influenza  has  been  re- 
sponsible for  a  definite  increase  in  the  prevalence  of  nerve 
disorders.  Whatever  the  special  form  its  attack  has 
taken  the  influenzal  poisoning  has  always  proved  par- 
ticularly virulent  to  the  tissues  of  the  brain.  Weeks 
after  what  has  appeared  to  be  a  minor  illness,  its  victims 
have  often  found  nervous  instabihty,  depression,  headache, 
lassitude,  and  impaired  mental  vigour  bothering  them. 
When,  as  sometimes  happens,  influenza  attacks  the 
nervous  system  at  the  very  outset  of  the  illness  all  these 
symptoms  quickly  appear  and  are  greatly  accentuated. 
Severe  mental  depression  following  influenza  is  one  of 
its  most  serious  sequels,  and  no  manifestation  of  post- 
influenzal neurasthenia  can  be  regarded  lightly.  All 
acute  fevers  deplete  the  nervous  system,  and  may  lead 
to  some  degree  of  nervous  weakness.  The  longer  the 
febrile  state,  that  is,  of  course,  the  longer  the  poisoning, 
the  worse  for  the  nervous  system  ;  thus  typhoid  fever 
with  its  acute  stage  of  three  weeks  is  not  at  all  unlikely 
to  leave  neurasthenia  behind  it.  Even  a  common  cold 
may  be  sufliciently  severe  to  induce  considerable  im- 
poverishment of  nerve  energy.  At  the  present  time  two 
acute  diseases  must  be  given  a  prominent  place  here. 
Both  are  associated  with  war  conditions,  although  one — 
malaria — has  always  been  productive  of  a  certain  num- 
ber of  neurasthenic  cases  amongst  those  working  in 
tropical  climates.  The  other  is  trench  fever,  which 
although  often  mild  in  the  acute  stage,  nevertheless 
frequently  leaves  a  weakened  nervous  system  behind 
it.  Indeed,  the  neurasthenia  resulting  from  this  war- 
disease  is  one  of  its  most  troublesome  possibilities,  and 


CONDITIONS  PREDISPOSING  TO  BREAKDOWN    75 

in  part  accounts  for  the  importance  which  it  has  achieved 
in  the  sight  of  the  medical  world. 

AU  exhausting  conditions  such  as  abscesses,  boils, 
and  carbuncles,  will  if  prolonged  reduce  nerve-energy 
and  bring  about  a  neurasthenic  state  ;  and  so  will  all 
chronic  infections  resulting  in  persistent  poisoning.  Of 
these,  pus-forming  at  the  roots  of  the  teeth — pyorrhoea 
alveolaris  or  Rigg's  disease — has  perhaps  been  blamed 
more  severely  than  necessary  for  bringing  about  neuras- 
thenia. Where  any  source  of  persistent  formation  of, 
poisonous  matter  can  be  demonstrated  we  may  be  cer- 
tain that  health  in  general,  and  nerve-health  in  par- 
ticular, must  be  prejudiced  thereby.  But  it  is  a  serious 
matter  to  have  all  one's  teeth  out  for  a  slight  pyorrhoea 
on  the  supposition  that  it  alone  is  the  cause  of  a  neur- 
astlienic  state.  Strangely  enough,  it  is  often  forgotten 
that  severe  nervous  debility  of  itself  represents  a  state  of 
impoverishment  which  gives  germs  a  good  opportunity 
for  attacking  the  roots  of  the  teeth.  Time  and  again 
pyorrhoea  is  demonstrably  secondary  to  neurasthenia.  It 
is  stated  that  we  must  have  all  our  teeth  out  to  cure  our 
nerves  ;  why  are  we  never  advised  to  have  our  nervous 
system  toned  up  to  save  our  teeth  ?  The  fact  is  •  there 
can  be  no  general  rule,  but  this  word  of  precaution  may 
save  some  from  unnecessary  discomfort  and  incon- 
venience. Of  other  common  infections  tuberculosis  is 
one  that  sometimes  leads  to  nervous  debility  ;  on  the 
whole,  the  poison  of  tuberculosis  does  not  specially 
impair  nerve  tissues,  but  it  must  not  be  overlooked  as 
a  possible  cause  of  instability.  On  the  other  hand,  the 
poison  of  syphilis  is  deadly  to  every  ceU  and  fibre  in  the 
brain  and  nervous  system  ;  countless  are  the  wrecks 
that  result  from  this  special  action  of  syphilitic  infection. 

Many  nervous  breakdowns  are  caused  by  accidents. 
Shocks  sustained  through  being  thrown  out  of  a  carriage, 
caught  in  a  railway  disaster,  or  through  some  mischance 
of  motoring  not  infrequently  produce  a  collapse  of  nerv- 


76  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

ous  function  that  it  is  very  difficult  to  remedy.  The 
chief  features  of  this  condition  are  loss  of  memory  and 
physical  power  expressed  in  all  degrees  from  slight 
diminution  to  complete  paralysis  or  aberration  of  mind. 
Trembling,  local  pain,  sleeplessness,  depression,  inability 
to  read,  indigestion  and  sensations  of  all  kinds  persis- 
tently tormenting  the  sufferer  are  also  commonly  seen. 
The  incapacitating  effects  of  nervous  instability  due  to 
accidents  are  well  known  to  employers  of  labour,  and 
traumatic  neurasthenia — as  It  is  technically  known — 
occasions  many  difficult  problems  in  regard  to  insurance 
and  compensations.  Very  often  the  shock  to  the  nervous 
system  is  out  of  all  proportion  to  the  actual  injury,  as 
one  sees  when  the  victim  of  a  railway  accident  comes 
through  physically  whole,  but  soon  after  develops  signs 
of  severe  nerve  shock.  One  of  the  most  curious  features 
of  traumatic  neurasthenia  is  the  occasional  delay  in  the 
appearance  of  the  worst  symptoms.  Thus,  after  a  blow 
on  the  head  the  injured  person  may  feel  comparatively 
well  for  a  da.y  or  two  and  then  collapse  with  many  dis- 
tressing symptoms.  Similarly,  after  a  railway  or  motor- 
ing accident  there  may  be  a  considerable  interval  between 
the  shock  and  the  developing  of  the  illness. 

Increasingly  complicated  methods  of  transit  more  and 
more  expose  us  to  the  chances  of  small  accidents ;  the 
cumulative  effects  of  these  small  jars  and  accidents  must 
be  taken  into  serious  consideration  as  a  cause  of  nervous 
disorder,  as  they  gradually  lower  nerve-tone  until  one 
more  precipitates  breakdown.  Shell-shock,  of  which  we 
now  see  so  many  distressing  examples,  is  essentially  a 
form  of  traumatic  neurasthenia  with  special  relations. 
These  are  discussed  at  length  in  a  subsequent  chapter. 

The  miracles  of  modern  surgery  are  amongst  the  most 
marvellous  achievements  of  present-day  science.  Thou- 
sands of  people  owe  health,  happiness  and  prosperity  to 
the  operative  sldll  of  some  master  of  surgical  craft  ; 
indeed,  operations  are  a  common  necessity  of  life  to-day, 


CONDITIONS  PREDISPOSING  TO  BREAKDOWN     77 

and  until  the  time  comes  when  some  other  branch  of 
therapeutic  medicine  can  banish  disease  we  shall  have 
to  rely  on  and  be  grateful  for  them.  Nevertheless,  an 
operation  is  always  a  serious  thing,  and,  however  small, 
produces  some  nerve  shock.  More  frequently  than  is 
generally  understood  operations  cause  considerable  and 
lasting  nerve  shock,  so  that  instead  of  passing  into  health 
through  a  short  convalescence  the  invalid  is  caught 
in  the  miseries  of  a  neurasthenic  state  and  suffers 
much  therefrom.  Post-operative  neurasthenia  must  be 
reckoned  with  nowadays  as  an  important,  if  not  very 
common,  caiise  of  nervous  breakdown.  Care  in  pre- 
venting shock,  and  in  lessening  strain  after  an  operation, 
must  be  our  chief  means  of  obviating  this  unfortunate 
result. 

There  are  interesting  differences  in  the  response  of 
different  races  to  conditions  predisposing  to  neurasthenia. 
Dr.  Burr,  of  Philadelphia,  states  that  until  recently  the 
American  negro  did  not  suffer  from  neurasthenia,  but 
nowadays  nervous  breakdown  quite  commonly  occurs 
amongst  the  dark  citizens  of  the  United  States.  He 
makes  the  interesting  comment  that  "  apart  from  organic 
disease  and  bad  morals,  the  mere  struggle  of  the  best 
specimen  of  an  inferior  race  to  attain  the  plane  of  a 
superior  leads  often  to  theii*  downfall."  ^  As  an  excep- 
tion to  this,  it  has  often  been  noted  that  the  Jews 
wherever  they  may  be  settled  are  very  prone  to  nervous 
disorders.  Some  writers  have  suggested  that  this  is  a 
consequence  of  stabihty  being  weakened  by  centuries  of 
oppression.  Lately  we  have  had  the  word  of  an  army 
consultant  that  the  Turks,  in  military  life  at  any  rate, 
rarely,  if  ever,  suffer  from  nervous  breakdown. 

No  time  of  life  of  itself  guarantees  protection  from 
nervous  distress.  Octogenarians  troubled  with  morbid 
thoughts  are  not  unknown — indeed  the  neurasthenia  of 

^  Dr.  Burr,  of  Pliiladelphia,  Osier's  System  oj  Medicine,  Vol.  V, 
p.  628. 


78  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

old  age  should  be  recognized  more  definitely  than  it  is, 
whilst  at  the  other  extreme  of  life  indications  of  instability 
in  infancy  are  often  met  with,  and  attacks  of  excitement  as 
well  as  morbid  fears  and  fancies  are  quite  common  between 
three  and  twelve  years.  Of  special  periods,  that  from 
eighteen  to  about  thirty-five  years  of  age  is  very  pro- 
lific of  breakdown.  Many  men  of  nervous  temperament 
go  through  a  time  of  particularly  bad  nerve-health  be- 
tween eighteen  and  twenty-five,  and  then  again  fail  at 
about  thirty-five  if  they  are  not  careful.  Certainly  after 
this  age  every  year  of  good  health  argues  well  for  increas- 
ing freedom  from  nerve -weakness.  Special  distinction 
between  the  manifestations  of  nervous  instability  at 
different  times  of  life  may  be  made  by  saying  that  in 
childhood  they  are  characterized  chiefly  by  excitement 
and  in  senility  by  depression.  Of  hysteria  it  is  true  that 
it  is  so  rare  after  fifty  that  if  occurring  in  later  life  it  may 
very  likely  be  mistaken  for  some  other  malady.  Cases  of 
severe  hysterical  disturbances  in  advancing  years  are 
recorded  from  time  to  time  as  matters  of  interest. 


PART  II 

THE  VARIETIES    OF    NERVOUS 
BREAKDOWN 


CHAPTER  I 

FORMS  OF  NERVOUS  BREAKDOWN 

Harmony  of  fiinction  necessary  for  health — Basis  of  control — Central 
nervous  system — The  brain  the  seat  of  government — Ramification 
of  nerve  fibres — The  term  "  nerves  " — Nerves  in  disorder — The 
nervous  type — Classification  of  nervous  diseases — Relations  of 
nervous  breakdown — Tlu'ee  chief  groups— Nem'asthenia — Hysteria 
— The  so-called  borderland — Terms  in  common  use — Psycho - 
neurosis — Psychasthenia. 

WE  breathe  and  eat,  think  and  speak,  work  and  play, 
whilst  all  the  time  a  multitude  of  active  processes 
are  being  carried  out  within  our  bodies  ;  somewhere  there 
is  a  governing  power  that  Hnks  up  in  harmony  the  mjn^iad 
transactions  of  countless  glands  and  ceUs,  selecting  and 
separating  the  gases  we  breathe  in  and  out,  eliminating 
waste  products,  destroying  poisons,  buUding  up  chosen 
elements  into  the  various  tissues.  Somewhere  there  is  a 
controller  who  prevents  undue  supplies  of  nourishment 
being  sent  to  areas  where  they  are  not  needed,  or  toxic 
substances  accumulating  in  others  ;  whilst  all  the  time 
providing  increased  supplies  where  there  is  a  call  for  them. 
Somewhere  there  is  a  censor  checking  the  messages  that 
ceaselessly  fly  along  the  nerve-fibres  which  are  the  tele- 
graph wires  of  the  body.  Were  it  not  for  this  power  which 
governs  and  controls  supply  and  demand — this  higher 
command — ^the  workings  of  the  human  system  would 
soon  end  in  chaos.  Soon,  for  example,  would  the  diges- 
tive juices  turn  against  the  living  tissues  which  produce 
them  ;  quickly,  indeed,  would  the  body  break  up  and 
dissolve  under  the  impact  of  its  own  forces.  No  large 
effort  of  imagination  is  required  to  realize  the  necessity 
of  a  mentally  active  agent  to  look  after  these  things  so 

G  81 


82  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

ably,  and  to  conceive  some  mechanism  by  which  its 
orders  can  be  carried  out  and  co-ordinated.  The  con- 
trolling power  is,  of  course,  a  term  of  mind,  and  the 
mechanical  apparatus  which  acts  as  the  switch-board  and 
telegraphic  exchange  for  the  whole  vast  business  is  that 
miracle  of  miracles  we  call  the  brain. 

In  some  form  or  another  a  nervous  system  central  board 
of  control  can  be  found  in  all  grades  of  animal  life  ;  even 
where,  as  in  the  lowest  tjrpes,  the  whole  organism  consists 
of  but  a  single  cell,  that  cell  directly  responds  to  its  sur- 
roundings, and  apart  from  its  other  properties  exhibits 
those  particular  characteristics  which  we  call  nervous.  As 
one  traces  development  in  the  animal  kingdom,  the  more 
complicated  does  the  nervous  system  become,  until  in 
mankind  one  finds  it  in  its  highest  stage  of  development, 
consisting  of  large  nerve  centres  respectively  controlling 
such  vital  functions  as  respiration,  circulation,  balance, 
movement,  and  sensation ;  the  whole  governed  through 
the  brain,  which  not  only  co-ordinates  the  various  organs  of 
the  body,  but  is  the  seat  of  consciousness  and  of  all  mental 
faculties — will,  understanding,  memory,  imagination  and 
attention.  Actual  connection  between  the  brain,  nerve- 
centres,  and  remote  parts  of  the  body  is  secured  through 
the  maze  of  nerve-cords  that  extend  to  every  corner, 
and  some  idea  of  the  ramifications  and  intricacies  of  the 
nerve-fibres  linking  up  the  different  tissues  with  each 
other  and  with  the  brain  may  be  obtained  by  comparing 
them  to  the  skeleton  of  a  leaf.  The  delicate  net-work  of 
fibres  that  constitute  the  ground-work  of  a  leaf  is  familiar 
to  everyone,  and  if  one  could  free  the  nerve-cords  through- 
out the  body  just  as  children  sometimes  dissect  out  a 
leaf's  fibrous  skeleton,  which  in  itself  retains  the  shape  and 
outline  of  the  leaf,  so  should  we  find  that  the  nerve-tissues 
would  give  the  shape  and  outline  of  the  human  body.  ^ 

1  For  detailed  description  of  the  structure  and  functions  of  the 
central  nervous  system  the  reader  may  be  referred  to  the  author's 
book  for  nurses  and  students  entitled  Notes  on  the  Nervous  System, 
published  by  the  Scientific  Press,  Ltd. 


FORMS  OF  NERVOUS  BREAKDOWN     83 

So  dolicate  in  structure  and  far-reaching  in  connection, 
it  would  certainly  be  surprising  were  the  human  nervous 
system  not  very  responsive  to  adverse  conditions  ; 
it  is,  indeed,  this  extreme  sensitiveness  that  leads  to 
those  unpleasant  and  incapacitating  troubles  which 
we  familiarly  and  collectively  call  "  nerves."  Be  it 
noted,  however,  that  the  popular  and  medical  use  of 
the  term  "  nerves  "  is  not  in  conformity  with  its  meaning 
in  physiological  or  anatomical  nomenclature.  Strictly 
speaking,  the  scientific  use  of  the  word  "  nerves  "  is  to 
indicate  those  particular  strands,  strings,  or  wires  of 
nervous  tissue  which  are  the  main  connecting  links  of  the 
body,  and  which  have  just  been  particularly  referred  to. 
However,  in  the  sense  of  a  general  disturbance  of  the 
nervous  system  expressed  both  by  mental  and  physical 
manifestations — as,  for  example,  the  equivalent  of 
neurasthenia,  or  nervous  breakdown — "  nerves  "  has 
come  to  stay.  It  has  the  merit  of  conveying  a  meaning 
well  known  to  everyone  ;  it  certainly  is  brief  and  to  the 
point. 

When  we  come  to  study  the  characteristics  of  people 
suffering  from  nervous  breakdown,  it  is  found  that  two 
main  groups  of  cases  present  themselves.  The  first 
consists  of  those  who  from  early  years  have  suffered 
from  troubles  of  all  kinds  ;  the  second  includes  people 
whose  stores  of  energy  have  proved  sufficient  for  many 
years,  yet  who  one  day  find  themselves  unable  to  main- 
tain nerve  health.  Those  of  the  first  group  are  the  more 
unfortunate  ;  constitutionally  weak  in  regard  to  their 
nerve-strength  they  are  habitually  subject  to  a  series  of 
-troubles  which  are  exceedingly  distressing  and  persistent. 
They  suffer  all  sorts  of  pains  and  penalties  for  enjoying 
themselves  ever  so  little  ;  they  are  in  many  cases  tor- 
tured by  the  knowledge  that  they  possess  great  mental 
ability  without  having  the  necessary  nerve-energy  to 
produce  work  of  a  high  order  without  extreme  fatigue. 
Indeed,  as  a  rule,  the  nervous  subject  is  able  to  do  much 


84  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

less  steady  work  than  a  normal  individual,  but,  at  the 
same  time,  he  is  often  able  to  accomplish  three  or  four 
times  as  much  in  a  short  spell  of  activity.  In  fact, 
monumental  labours  have  been  accomplished,  in  spite 
of  their  natural  infirmity,  by  people  whose  nerves  were 
never  properly  ordered. 

As  was  noted  in  a  previous  chapter  persons  of  nervous 
temperament  form  a  fairly  definite  type,  and  one  which 
can  readily  be  recognized  amongst  those  around  us.  Thej 
are  frequently  thin  and  delicately  formed.  Quick  and 
intelligent  beyond  their  fellows,  they  enter  into  whatever 
they  take  up  with  the  utmost  zeal,  but  tire  rapidly  before 
they  have  gone  very  far  with  it.  Their  minds  are 
active,  and  jump  quickly  from  one  subject  to  another. 
Moreover,  they  have  a  greater  capacity  for  enjoyment, 
and  a  greater  ability  for  misery  than  the  ordinary  phleg- 
matic individual.  These  are  the  people  who  disagree 
with  their  relations,  and  whose  friends  fail  to  understand 
them.  The  fact  is,  their  quickness  of  intellect  is  often 
difficult  to  follow  for  the  ordinary  individual  who  would 
understand  them  if  he  could,  and  only  fails  to  do  so 
through  want  of  attention  rather  than  want  of  intention. 
Again,  their  natural  sensitiveness  often  leads  them  to 
think  much  about  themselves,  whilst  their  friends  are 
thinking  comparatively  little  about  them.  It  is  one  of 
the  most  difficult  things  for  a  person  of  nervous  tempera- 
ment to  realize  that  he  himself  tends  to  over-estimate 
his  own  importance  in  the  eyes  of  those  around  him. 
Many  such,  when  once  they  appreciate  the  fact  that  they 
are  morbidly  sensitive,  begin  to  talk  much  less  about 
being  misunderstood. 

Practical  consideration  of  the  varieties  of  nervous 
breakdown  necessitates  an  attempt  at  classifying  a  num- 
ber of  allied  conditions  that,  indeed,  do  not  conveniently 
fall  into  definite  groups.  From  the  point  of  view  of 
scientific  description  there  is  far  too  much  overlapping 
of  characteristics,  and  at  best  it  will  not  be  found  possible 


FORMS  OF  NERVOUS  BREAKDOWN  85 

to  divide  our  different  types  in  such  a  way  as  to  provide 
the  proper  pigeon-hole  for  each  case.  After  all,  nervous 
breakdown  varies  from  a  trivial  sense  of  discomfort  or 
abnormal  uneasiness  after  work  to  such  complete  collapse 
that  mental  and  physical  functions  are  for  the  time  being 
in  abeyance.  Between  these  two  extremes  are  to  be 
found  a  host  of  grades  of  disability.  Some  of  these  are 
expressed  chiefly  in  terms  of  physical  disorder,  some 
cause  emotional  mental  inconvenience,  whilst  yet  others 
trouble  their  victims  in  both  mind  and  body.  In  a  word, 
at  one  end  of  the  scale  are  to  be  found  the  simple  ex- 
haustion cases,  the  obsessing  thoughts,  the  functional 
paralysis  and  similar  disturbances  ;  while  at  the  other 
lies  mental  collapse. 

Let  it  be  said  at  once  that  our  consideration  of  nervous 
breakdown  stops  short  of  those  iQstances  where  the 
derangement  of  mind  is  so  great  that  insanity  results. 
There  are  necessarily  affinities  between  all  forms  of 
disorder  affecting  any  particular  system  ;  all  kinds  of 
heart  disease,  or  aU  kinds  of  lung  trouble  are  to  some 
extent  expressed  by  similar  signs.  But  just  as  a 
man  may  suffer  from  pleurisy,  for  example,  without 
ever  being  in  danger  of  becoming  consumptive,  so 
thousands  of  people  are  brought  down  by  kinds  of 
nervous  disorder  which  never  really  endanger  their 
sanity.  Mental  disorders  which  inevitably  and  always 
occasion  insanity  form  a  large  and  important  gToup  of 
maladies  which  do  not  come  within  the  scope  of  this 
work.  We  have  sufficient  to  concern  us  in  the  con- 
sideration of  those  varieties  of  nervous  disorder  which 
come  within  the  ordinary  designations  of  neurasthenia, 
psychasthenia,  and  hysteria.  In  many  cases  these  ill- 
nesses are  so  severe  as  to  take  those  suffering  from  them 
into  the  dangerous  "  borderland  "  between  sanity  and 
insanity  ;  sometimes,  but  not  commonly,  that  border- 
land is  crossed  with  disastrous  consequences.  In 
everyday  usage  the    expression  nervous  breakdown  is, 


86  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

indeed,  used  at  times  to  indicate  every  possible  kind 
of  nervous  and  mental  disorder  ;  nowadays  it  appears 
to  be  more  and  more  frequently  employed  when  the  sole 
justification  for  this  is  consideration  of  the  feelings  of 
invalids  suffering  from  insanity  or  their  friends.  It  is 
desirable  to  point  out  that  here  such  a  wide  extension  of 
the  employment  of  the  term  is  not  contemplated. 

It  may  be  said  at  once  that  cases  of  nervous  break- 
down as  it  commonly  presents  itself  fall  into  two  hroad 
groups.  Of  these  one  is  made  up  of  maladies  expressing 
exhaustion  or  inherent  weakness  of  the  nervous  system 
with  certain  associated  conditions  of  mind.  Such  are 
the  neurasthenic  cases.  The  other  class  of  case  exhibits 
a  peculiar  mental  instabihty  accompanied  by  excessive 
suggestibility  and  those  remarkable  reactions  between 
mind  and  body  which  make  up  the  condition  we  know  of 
as  hysteria.  These  terms  are  not  enthely  satisfactory  in 
that  they  signify  recognizable  combinations  of  nervous 
symptoms  rather  than  definite  and  readily  describable 
diseases  ;  but  as  they  are  commonly  in  use  we  may  as  well 
keep  them  until  we  are  provided  with  something  better. 
Certainly  they  are  better  than  the  designation  "  mental," 
which  is  still  not  infrequently  used  to  mdicate  a 
variety  of  disorders  difficult  to  diagnose,  particularly 
by  nurses  and  students  who  have  not  yet  become  accus- 
tomed to  differentiating  the  various  groups.  For  junior 
practitioners  there  is  the  doubtful  excuse  for  the  hap- 
hazard use  of  such  indefinite  terms  that  without  consider- 
able experience  mental  and  nervous  maladies  are  difficult 
to  understand,  opportunities  given  for  studying  them  m 
student  years  are  usually  Hmited,  and  the  stress  laid 
upon  them  at  examinations  is  trivial. 

Owing  to  the  common  combination  of  mental  with 
physical  symptoms  in  the  conditions  under  notice  the 
expression  psycho-neurosis  has  come  into  increasing  use 
of  late  years  ;  beyond  the  fact  that  it  is  a  more  imposing 
title  it  would  appear  to  have  no  advantages  over  that 


FORMS  OF  NERVOUS  BREAKDOWN     87 

just  considered.  After  all,  psycho-neurosis  merely  con- 
veys an  indication  of  some  condition  in  which  the  physi- 
cal nerve-trouble  is  combined  mth  signs  of  disorder  in 
the  field  of  thought,  and  therefore  takes  us  no  further. 
Again,  many  writers  make  a  separation  of  nerve  cases 
according  to  the  predominance  of  mental  symptoms  or 
physical  troubles,  using  the  term  psychasthenia  for  the 
former,  whilst  reserving  neurasthenia  for  the  latter. 
As  a  general  rule,  psychasthenia  is  employed  to  indicate 
an  inherent  neurasthenic  tendency  ultimately  expressed 
by  head  symptoms,  obsessions,  and  morbid  fears.  To 
repeat,  then,  the  term  neurasthenia  is  used  herein  as 
a  convenient  expression — made  still  more  convenient  by 
usage,  but  with  certain  hmitations — to  signify  that  kind 
of  impaired  physical  health  or  disturbed  mental  har- 
mony which  is  found  when  the  brain  or  central  nervous 
system  generally  is  deficient  in  vitahty,  whether  such 
deficiency  is  primarily  dependent  on  causes  operating 
in  the  body  or  in  the  mind.  And  to  understand  just  what 
sort  of  abnormality  neurasthenic  conditions  indicate 
it  must  be  realized  that  the  crux  of  the  whole  matter  lies 
in  the  condition  of  the  brain  and  dependent  nervous 
centres.  Both  body  and  mind  depend  for  their  harmoni- 
ous working  on  fitness  of  these. 

Thus  under  the  heading  neurasthenia  are  to  be 
considered  all  the  common  forms  of  nervous  exhaustion 
with  mental  and  physical  fatigue  after  comparatively 
little  exertion,  and  varied  subjective  sensations  ;  also 
those  curious,  but  very  troublesome,  states  of  anxiety — 
the  "  anxiety  neuroses  " — which  stand  out  so  promi- 
nently that  there  is  a  tendency  to-day  to  gToup  them 
apart  from  neurasthenic  troubles  proper.  Nervous 
indigestion,  a  common  manifestation  of  nem'asthenia 
and  a  bane  of  innumerable  chronic  invalids,  will  be  dis- 
cussed in  a  separate  chapter,  as  will  also  the  obsessional 
conditions,  including  the  various  morbid  fears,  doubts, 
and  scruples.    After  the  difficult  subject  of  neurasthenia 


88  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

has  been  reviewed  in  its  various  relations  consideration 
will  be  given  to  the  problem  of  hysteria  which  will  then 
be  seen  to  have  characteristics  which  definitely  separate 
it  from  the  neurasthenic  type  of  nervous  breakdown. 
Finally,  and  in  a  special  part,  will  be  grouped  those 
forms  of  disorder  particularly  attributable  to  the  special 
conditions  of  war-strain  and  shell-shock. 


CHAPTER  II 

THE  NEURASTHENIC  STATE 

Nexiraathenia — L'homme  a  petits  papiers — Common  neurasthenic 
symptoms — The  question  of  subgroups — Le  casquet  neurasthenique 
— Other  head  troubles — Weakening  of  self-cofitrol — Fear  of  losing 
reaison — Stevenson's  picture  of  collapse  from  over-work — General 
consequences  of  ne\irasthenia — Heart  and  circulation — Over- 
sensitiveness — Some  typical  examples. 

OUR  endeavour  now  must  be  to  comprehend  the 
essential  features  constantly  appearing  in  neuras- 
thenic states,  particularly  that  state  of  irritable  fatigue 
which  so  often  evidences  a  disturbed  and  tired  nervous 
system,  and  in  knowing  this  characteristic  of  irritable 
fatigue  one  begins  at  once  to  understand  why  it  is  that 
this  form  of  nervous  breakdown  presents  such  varied 
pictures  ;  one  sees  that  the  exhausted  nervous  system 
responds  just  as  does  an  over-strained  violin  which  gives 
out  all  sorts  of  strange  disharmonies.  At  the  outset 
it  may  be  noted  that  infinite  in  their  variety  as  are  the 
symptoms  of  neurasthenia  they  tend  to  appear  time 
and  again  in  particular  combinations ;  hence  writers 
have  found  it  convenient  to  speak  of  such  different  types 
as  cerebral  nem-asthenia,  spinal  neurasthenia,  gastric 
neurasthenia,  sexual  neurasthenia,  and  cardiac  neuras- 
thenia. As  all  the  symptoms  which  occur  in  these  so- 
caUed  types  are  dependent  upon  a  lowering  of  vitality 
in  the  nervous  system  as  a  whole,  the  description  of 
such  subgroups  as  distinct  types  of  neurasthenia  is  not 
scientific.    Neither,  indeed,  does  it  accord  with  experi- 

89 


90  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

ence.  No  invalid  is  ever  neurasthenic  as  regards  head, 
heart,  spine,  or  stomach,  without  being  neurasthenic  in 
other  respects  also.  There  is  a  danger  that  in  dwelling 
too  closely  on  the  symptoms  most  prominent  in  any 
particular  instance  the  ilhiess  as  a  whole  may  be  mis- 
understood. 

As  the  term  suggests,  neurasthenia  is  essentially  a 
manifestation  of  fatigue.  Exhaustion  of  body  and  limbs, 
tiredness  of  mind,  failure  of  attentive  power,  characterize 
the  neurasthenic  state  and  are  responsible,  individually 
or  in  combination,  directly  or  indnectly,  for  all  its 
troubles.  Fatigued  nerve  centres  show  theu-  state  by 
enfeebled  work  and  over-quick  reaction  ;  they  are  in  a 
state  of  "  irritable  weakness."  The  neurasthenic  is 
certainly  a  weakened  and  excitable  individual.  Loss  of 
strength  is  expressed  in  every  line  of  his  body  as  he  walks 
into  one's  room  either  with  faltering  steps  or  with  a  swift 
jerky  manner  that  is  quickly  changed  for  one  of  slack- 
ness as  he  collapses  weakly  into  a  comfortable  chair. 
Otherwise  the  nerveless  grip  and  tired  face  give  a  clue  to 
his  want  of  nerve  energy.  Then,  again,  he  is,  as  the 
great  Charcot  used  to  say,  "  I'homme  a  petits  papiers," 
and,  indeed,  he  may  well  be  sympathised  with  for  so  often 
bringing  a  sheaf  of  little  slips  of  paper,  for  his  discom- 
forts are  innumerable,  his  symptoms  legion,  and  his 
miseries  great.  Little  wonder  that  in  reasonable  anxiety 
to  get  rid  of  this  persistent  incapacity  that  is  hampering 
him  at  every  turn,  the  neurasthenic  is  careful  to  make 
a  written  record  of  his  troubles  lest  in  the  anxieties  of 
the  moment  he  may  omit  to  tell  the  doctor  something  of 
importance. 

The  typical  story  of  neurasthenia  is  that  the  sufferer 
is  harassed  by  a  tiredness  that  never  leaves  him  ;  even  by 
night  he  is  not  rested,  for  he  wakes  continually  and  in  the 
intervals  of  broken  sleep  feels  the  oppressing  sense  of 
his  fatigue  still  with  him.  Aiter  the  restless  night  the 
day  dawns  without  hope  that  the  load  will  be  lightened 


THE  NEURASTHENIC  STATE  91 

and   he   may  well  feel   inclined  to   exclaim   with    the . 
Dauphin,  in  King  John  : 

"  There's  nothing  in  this  world  can  make  me  joy. 
Life  is  as  tedious  as  a  twice-told  tale. 
Vexing  the  dull  ear  of  a  drowsy  man."  '^ 

Headache  or  distressing  sensations  of  some  kind  refer- 
able to  the  head,  difficulties  with  digestion,  and  mental 
depression  commonly  find  their  place  in  the  list  of  primary 
symptoms.  Added  to  this,  one  is  invariably  told  of  a 
host  of  other  distressing  things,  and  as  just  remarked, 
according  to  then  distribution  and  combination  it  has 
been  customary  to  divide  neurasthenia  into  a  series  of 
subgroups  labelled  with  the  names  of  those  symptoms 
which  are  most  prominently  associated  with  them  in 
individual  cases.  Certainly  under  some  circumstances  it 
may  be  very  convenient  to  note  that  cases  tend  to  fall 
into  groups  in  which  particular  symptoms  predominate, 
but  let  it  be  repeated,  neurasthenia  must  be  treated  as 
a  breakdown  of  the  nervous  system  and  its  relations  to 
the  body  as  a  whole,  rather  than  regarded  as  a  weakness 
that  can  pick  out  brain,  heart,  stomach,  for  example, 
without  distm'bing  other  parts. 

Taking  the  most  prominent  troubles  of  the  neuras- 
thenic in  further  detail  one  may  at  first  consider 
symptoms  referred  to  the  head,  which  are  of  wide 
range,  an  infinite  variety  of  aches,  pains,  or  sensations 
in  the  head  being  described.  Typically,  the  nem^asthenic 
headache  is  felt  rather  as  a  weight  or  pressure  than  as  a 
sharp  pain.  Those  afflicted  say  that  they  feel  as  if  their 
^  heads  were  being  gripped  in  a  vice,  or  as  if  a  heavy  iron 
helmet  were  weighing  them  down ;  hence,  French 
writers  have  used  the  term  "  le  casquet  neurasthenique." 
Sometimes,  instead  of  a  wide  area  of  pressure,  the  sensa- 
tion is  as  if  a  smaU  ring  or  plate  of  hard  material  were 
pressed  on  to  the  scalp.     This  "  pressure  headache  "  is 

^  Shakespeare's  The  Life  and  Death  of  King  John,  Act  III,  Sc.  4. 


92  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

very  persistent,  and  some  people  suffer  from  it  on  and 
off  for  many  years.  However,  it  is  by  no  means  the  only 
form  of  head  sensation  suffered  by  neurasthenics,  who 
not  infrequently  complain  of  sharp  pains  darting  through 
the  scalp.  The  persistence  of  the  ache,  or  the  sharpness 
of  the  "shooting  pains,"  often  leads  the  invalid  to 
suppose  that  his  brain  is  seriously  diseased,  and  one 
has  known  instances  in  which  the  victim  of  a  chronic 
localized  headache  has  consulted  doctor  after  doctor  until 
he  has  persuaded  a  surgeon  to  operate  under  the  im- 
pression that  there  has  been  something  to  be  removed. 
Under  such  circumstances,  however,  nothing  will  be 
found,  although  it  does  sometimes  happen  that  the 
mental  or  moral  effect  of  the  experience  is  to  banish  the 
headache  for  a  time.  So  various  are  other  head  sensa- 
tions commonly  met  with  in  neurasthenia  that  they  can 
best  be  described  in  the  actual  words  of  some  who  have 
suffered  from  them.  Thus,  one  has  had  to  note  at  times 
such  definitions  as  the  following  :  Sense  of  emptiness  ; 
feeling  as  if  the  top  of  the  head  was  coming  off  ;  sensa- 
tions of  distension  of  head  ;  head  feeling  light  ;  sense 
of  constriction  ;  sensation  of  water  rushing  about  in  the 
head  ;  as  if  the  "  nerve  running  in  the  centre  of  the  head  " 
was  inflamed  ;  a  band  tied  round  the  forehead. 

So  closely  associated  with  these  head  sensations  are 
certain  mental  annoyances  that  some  of  the  latter  can 
be  conveniently  reviewed  at  once,  consideration  in  detail 
of  others  being  reserved  for  another  chapter.  They 
include  great  fatigue  and  "  brain  fag  "  as  soon  as  an 
attempt  is  made  to  attend  to  anything  requiring  per- 
sistent attention  ;  mental  depression  ;  impairment  of 
memory  ;  sense  of  confusion  and  feeling  that  the  sufferer 
has  "  lost  control  of  his  thoughts."  Particularly  where 
he  has  the  not  uncommon  sensation  of  thoughts  racing 
through  the  head  or  going  "  round  and  round,"  is  this 
distressing  s^ense  of  lost  control  very  prominent.  When  it 
is  then  feared  that  these  things  portend  loss  of  reason  there 


THE  NEURASTHENIC  STATE  93 

is  for  this  reason  added  misery.  The  following  notes 
illustrate  some  of  the  more  common  and  pressing  mental 
troubles  of  the  neurasthenic  state ;  they  are  given 
verbatim  : 

"  Very  impressionable  and  emotional  and  suffered 
aD.  his  life  from  subjective  symptoms  and  attacks  of 
depression." 

"Mental  fatigue  "  (an  expression  which  occurs  time 
after  time  in  one's  case  books). 

"  Disturbed  sleep." 

"  Troubled  with  thoughts,  chiefly  at  bed  time,  songs, 
tunes,  and  so  forth  obsessing  his  mind." 

"  Thoughts  constantly  dwelling  on  health." 

"  For  many  years  bothered  with  nerve  storms, 
attacks  of  temper  and  nervousness." 

"  Nervous,  imaginative,  and  introspective." 

"  Mental  confusion  and  nervousness." 

"  Depression,  with  morbid  ideas." 

"  Attacks  in  which  he  felt  he  must  rush  out  of  the 
room,  being  then  filled  with  great  apprehension  and 
sense  of  acute  depression." 

"  Morbid  thoughts  always  associated  with  unpleasant 
things." 

"  A  state  of  mind  in  which  he  felt  strained  and 
excited." 

There  are  other  mental  miseries  in  neurasthenia.  Very 
distressing  are  the  morbid  fears  and  doubts  or  other 
obsessing  thoughts.  So  frequent  and  so  troublesome  are 
these  that,  as  with  the  gastric  accompaniments  of  the 
neurasthenic  state,  a  special  chapter  is  given  to  their 
detailed  consideration.  Whether  or  not  nervous  debiUty 
brings  with  it  special  obsessions,  severe  mental  depres- 
sion, or  other  well-defined  mental  torment,  it  invariably 
occasions  a  sense  of  irritability  which  is  quite  charac- 
teristic. The  sufferer  from  neurasthenia  is  irritated  by 
a  host  of  things  which  would  not  be  noticed  in  health, 


94  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

and  not  uncommonly  gives  way  to  emotional  reactions 
expressing  displeasm^e.  Hence,  a  leading  object  in  treat- 
ment must  always  be  the  regaining  of  self-control  ;  the 
resumption  of  mastery  over  manner,  method  and  temper. 
It  is  a  matter  of  interest  that  in  neurasthenia  irritability 
of  temper  commonly  seems  to  be  most  troublesome  in 
those  of  the  dyspeptic  tjrpe. 

Mental  discomforts  of  a  nem-asthenic  order  often  occm^ 
because  people  do  not  soon  enough  heed  warnings  which 
should  be  sufficient  to  tell  them  that  they  are  over-taxiQg 
their  strength.  The  over-pressed  man  of  affairs  who  has 
been  through  a  time  of  considerable  anxiety  begtas  to 
find  that  when  he  goes  to  bed  at  night  he  becomes  more 
wideawake  than  ever,  instead  of  falling  asleep  ;  and  the 
matters  with  which  he  has  been  concerned  in  the  day- 
time will  recur  to  his  mind.  He  begins  to  go  through 
interviews,  to  review  columns  of  figures,  to  think  out 
transactions  and  go  over  new  plans,  whilst  all  the 
time  he  feels  that  his  brain  is  "on  fire  "  and  that  sleep 
will  never  come.  The  continued  repetition  of  ideas  is  a 
constant  torture  ;  he  mentally  dictates  the  same  letter 
over  and  over  again  ;  or  adds  up  the  same  figures  time- 
after  time  ;  he  becomes  nauseated  with  the  recurring 
thought  of  plans  and  prospects.  A  few  nights  of  this  sort 
of  thing  rapidly  lowers  anyone's  store  of  nerve-energy, 
and  not  only  is  control  of  thoughts  lost  at  night,  but  in 
the  daytime  many  things  keep  bothering  which  there 
is  really  no  need  to  worry  about.  If  he  disregards  these 
warnings,  the  sufferer  soon  finds  that  his  work  becomes 
extremely  exhausting  ;  that  he  takes  a  very  long  time  to 
get  through  what  should  be  an  ordinary  day's  routine  ; 
that  his  days  are  miserable,  and  his  nights  wretched. 
Moreover,  feeling  that  thoughts  are  "  getting  beyond 
control,"  he  may  be  further  tormented  by  the  idea  that 
he  is  "  going  mad."  Unfortunately,  once  people  get  this 
idea  that  troubled  nights  and  racing  thoughts  are  a  sign 
of  oncoming  mental  trouble,  it  is  very  difficult  to  reassure 


THE  NEURASTHENIC  STATE  95 

them  ;  they  know  they  have  seriously  overtaxed  their 
strength,  and  they  are  not  at  all  certain  that  one's  hope- 
ful opinion  as  to  the  future  is  not  expressed  merely  to 
comfort  them  in  the  face  of  threatening  disaster.  But, 
as  a  matter  of  fact,  people  who  think  they  are  "  going 
mad  "  very  rarely  fulfil  theii'  tragic  expectations.  Conse- 
quently, when  they  make  this  terrifying  suggestion,  and 
ask  if  the  sensation  of  strain  so  often  present  means  that 
something  is  about  to  snap,  the  safe  thing  is  to  tell  them 
candidly  that  their  very  fear  is  almost  a  guarantee  of 
safety  in  this  respect.  When  a  neurasthenic  person  says  : 
"  My  one  dread  is  that  I  am  going  mad,"  then  one  can 
reply  with  confidence,  "  You  may  be  quite  certain  that 
you  are  not."  It  takes  a  very  gi'eat  deal  of  prolonged 
stress  and  strain,  or  some  sudden  shock  of  quite  excep- 
tional magnitude,  to  unhinge  the  human  mind  suddenly  ; 
and  it  is  a  matter  of  considerable  importance  that  this 
should  be  realized  more  generally,  if  only  for  the  peace  of 
mind  which  such  knowledge  will  bring  to  hundreds,  per- 
haps thousands,  of  people  who  are  continually  haunted 
by  this  dread  of  becoming  mentally  deranged. 

Nevertheless,  reckless  abuse  of  one's  nervous  system 
may  exhaust  it,  just  as  harsh  usage  will  wear  out  any  other 
delicate  mechanism,  or  neglect  of  an  electrical  battery 
result  in  its  failure.  The  vivid  pen  of  R.  L.  Stevenson 
has  given  us  a  picture  of  collapse  from  foolish  overwork 
that  stands  unrivalled.  He  relates  how  "  a  student, 
ambitious  of  success  by  that  hot,  intemperate  manner 
of  study  that  now  grows  so  common,  read  day  and  night 
for  an  examination.^  Day  after  day  and  night  after  night 
he  kept  up  the  strain  until  the  dawn  of  his  test,  when  on 
going  to  the  wdndow  to^  see  the  sun  rise,  '  nameless  terror 
seized  his  mind.'  ^  Rushing  out  into  the  street  he  felt 
restored.  '  Nothing  troubled  him  but  the  memory  of 
what  had  passed,  and  an  abject  fear  of  its  return.'  "  ^ 

^  R.  L.  Stevenson,  Memories  and  Portraits,  p.  21. 
2  Ibid.  3  Jiid.—  p.  22. 


96  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

Nevertheless,  persistent  over-strain — evidently  coupled 
with  a  strong  emotional  factor,  be  it  noted — hot-headed 
ambition  and  anxiety  to  succeed  spurring  him  on — had 
done  its  work.  This  over-anxious  student  had  brought 
upon  himself  the  miseries  of  nervous  breakdown,  as  can 
be  best  told  in  Stevenson's  own  vivid  words  :  "  He 
dared  not  retm-n  to  his  lodging  ;  he  could  not  eat  ;  he  sat 
down,  he  rose  up,  he  wandered  ;  the  city  woke  about 
him  with  its  cheerful  bustle,  the  sun  climbed  overhead  ; 
and  still  he  grew  but  the  more  absorbed  in  the  distress 
of  his  recollection  and  the  fear  of  his  past  fear.  At  the 
appointed  hour  he  came  to  the  door  of  the  place  of  ex- 
amination ;  but  when  he  was  asked,  he  had  forgotten  his 
name.  Seeing  him  so  disordered,  they  had  not  the  heart 
to  send  him  away,  but  gave  him  a  paper  and  admitted 
him,  still  nameless,  to  the  hall.  Vain  kindness,  vain 
efforts.  He  could  only  sit  in  a  still  growing  horror, 
writing  nothing,  ignorant  of  all,  his  mind  filled  with  a 
single  memory  of  the  breaking  day  and  his  own  intoler- 
able fear.  And  that  same  night  he  was  tossing  in  a  brain 
/V  fever."  ^  Such  a  story  can  only  have  been  obtained 
from  someone  who  could  recount  the  facts  from  actual 
experience  ;  it  could  scarcely  have  been  written  as  an 
exercise  of  imagination.  Stevenson's  moral  therefrom 
is  also  true  in  that  "  we  all  have  by  our  bedsides  the 
box  of  the  Merchant  Abudah,  thank  God,  securely 
enough  shut  ;  but  when  a  young  man  sacrifices  sleep 
to  laboiu",  let  him  have  a  care,  for  he  is  playing  with 
the  lock." 2 

Among  disturbances  of  general  health  associated  with 
neurasthenia,  indigestion  and  secondary  results  there- 
from are  often  conspicuous,  as  has  been  already  noted. 
In  addition,  disorders  affecting  heart  and  circulation 
are  commonly  responsible  for  pressing  physical  symp- 
toms.   Inevitably,  the  heart  and  blood-vessels  share  both 

1  R.  L.  Stevenson,  Memories  and  Portraits,  p.  22, 

2  Ibid.,  p.  23. 


THE  NEURASTHENIC  STATE  97 

in  the  slackness  of  the  neurasthenic  state  and  in  its 
quickness  of  response  to  impressions  of  all  kinds.  Thus, 
on  the  one  hand,  people  who  suffer  from  nervous  debility 
often  complain  of  palpitation,  sense  of  breathlessness 
or  sense  of  oppression  after  quite  a  little  effort  ;  and,  on 
the  other  hand,  attacks  of  palpitation,  feeling  as  if  the 
heart  is  going  to  stop,  and  irregularities  of  rhythm.  Often, 
indeed,  in  neurasthenia,  the  heart  is  so  sensitive  that  it 
starts  beating  wildly  for  very  little  cause  ;  almost  any- 
thing, going  upstairs,  drinkhig  a  glass  of  water,  taking 
a  Httle  coffee,  smoking  a  cigarette,  meeting  somebody 
unexpectedly,  hearing  bad  news,  sudden  noises,  are  all 
quite  sufficient  to  occasion  an  attack  of  palpitation  and 
distress.  It  is  not  surprising,  therefore,  that  the  neuras- 
thenic who  has  not  obtained  some  understanding  of  his 
trouble  often  sends  for  the  doctor  or  rushes  off  to  see  a 
speciaUst  after  one  of  these  attacks,  in  deadly  fear  that 
something  has  gone  seriously  wrong  with  his  heart.  The 
associated  slackness  and  irritability  of  blood-vessels,  and 
the  nerve-centres  controlling  them,  fully  account  for  the 
flushings  and  palings,  the  sensations  of  faintness,  as  well 
as  much  of  the  giddiness,  and  other  unpleasant  head  dis- 
comforts suffered  by  neurasthenic  people.  Where  the 
receipt  of  a  telegram,  the  sudden  ringing  of  a  bell,  the 
slamming  of  a  door,  or  other  trifling  incident  of  every- 
day life  sends  the  heart  off  into  a  run,  that  causes  a 
feehng  of  half-suffocation  with  a  distressing  throbbing  in 
the  throat  followed  by  prostration  with  sweating  and 
sense  of  coUapse,  it  is  hardly  to  be  wondered  at  that  great 
alarm  is  caused  in  the  family  circle  until  the  true  facts  of 
the  case  are  made  manifest.  Even  where  these  acute 
attacks  do  not  occur  to  occasion  distress  nervous  people 
are  often  bothered  with  that  irregularity  of  heart-beat 
which  causes  them  to  know  that  a  beat  is  missed 
every  now  and  then.  But  always  heart  jumpiness  ex- 
perienced in  neurasthenia  is  distressing  in  proportion 
to  the  anxieties  it  occasions.    The  sense  of  "  missing  a 


•98  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

beat,"  so  often  complained  of,  is  never  pleasant.  Once 
it  is  understood  to  be  of  no  special  significance,  and  cer- 
tainly not  to  suggest  heart  weakness,  the  thing  loses  its 
value  and  becomes  easily  regarded  as  one  of  those  minor 
discomforts  of  general  state  that  have  to  be  put  up  with 
until  a  better  level  of  nerve  health  is  secured.  As  a 
matter  of  fact,  it  is  not  so  muchthe  missing  of  the  beat 
that  causes  alarm  as  the  sudden  "  thump  "  experienced 
immediately  after  ;  such  occasional  thumping  may 
affect  anyone  who  is  tired  or  suffering  from  indigestion, 
but  particularly  troubles  those  whose  nervous  energies 
are  impoverished. 

Again,  the  extreme  sensitiveness  of  some  neurasthenic 
patients  occasions  them  a  great  deal  of  physical  dis- 
comfort which,  being  difficult  to  avoid,  further  depresses 
them.  This  hypersensitiveness  is  often  so  extreme  that 
the  sufferer  suffers  agonies  through  quite  slight  noises, 
and  is  unable  to  face  bright  daylight  without  the  assist- 
ance of  tinted  glasses.  No  doubt  the  same  sensitiveness 
is  responsible  for  the  morbid  attention  which  some  of 
those  debilitated  in  nerves  give  to  their  internal  organs. 
Once  they  become  aware  of  an  occasional  palpita- 
tion or  of  some  irregular  movement  of  stomach  and 
bowels — magnified  by  their  sensitiveness — ^they  fasten 
their  attention  on  it  and  build  up  a  host  of  morbid 
imaginations  about  what  is  going  on  inside  them. 

Associated  with  head  symptoms,  mental  or  physical, 
are  attacks  of  giddiness  which  occasion  much  distress. 
The  vertigo  of  neurasthenia  is  one  of  its  most  incapaci- 
tating manifestations.  Taking  the  form  of  attacks  of 
giddiness  which  come  on  quite  suddenly,  it  leads  to  a 
sense  of  uncertainty  and  apprehension  which  often  causes 
those  afflicted  to  require  the  services  of  a  constant  com- 
panion. Moreover,  simulating  as  it  does  grave  forms  of 
ear  and  brain  disease,  it  adds  its  quota  of  fear  to  the 
burden  already  carried.  Not  unnaturally,  the  attacks  of 
giddiness,  the  curious  sensations,  and  the  strange  noises 


/    THE  NEURASTHENIC  STATE  99 

in  their  ears  which  bother  many  neurasthenics  lead 
them  to  suppose  that  some  serious  disorder  is  proceeding 
within  their  heads,  and  this  fear  of  impending  disaster 
adds  greatly  to  their  nervousness.  Instances  in  which 
neurasthenia  is  characterized  by  undue  attention  to  sex 
questions  are  well  kno^vn  to  every  medical  man. 

At  this  stage  a  few  personal  histories  will  best  help  to 
illustrate  further  the  neurasthenic  state.  Let  us  con- 
sider at  the  outset  the  case  of  a  young  professional  man, 
intelhgent  and  anxious  to  get  on,  but  who  has  had  to 
give  up  work  owing  to  neurasthenia.  For  some  months 
past  a  condition  of  increasing  mental  and  physical 
fatigue  has  incapacitated  him  ;  at  the  same  time  he  has 
been  a  martyr  to  indigestion  and,  therefore,  unable  to 
keep  his  weight  up  by  an  ample  diet.  In  addition,  he 
has  been  bothered  by  attacks  of  giddiness  and  sense  of 
"  spinal  irritation."  Of  temperate  habit  and  a  steadj'^ 
worker  who  has  done  well  in  his  profession,  he  had 
married  two  or  three  years  previously  ;  then,  on  going 
to  live  in  a  tropical  country,  had  broken  down.  The 
picture  is  that  not  uncommon  one  of  a  man  somev/hat 
delicate  in  physique  and  nervous  in  temperament  who 
has  not  realized  his  limitations  until  they  have  been 
forced  upon  him. 

Another  man  gives  the  following  clear  account  of  his 
condition  and  its  onset.  "  Three  years  ago  I  had  a  bad 
fainting  attack,  and  since  then  I  have  suffered  from 
nervous  dyspepsia,  vertigo,  and  faintness,  inability  to 
concentrate  my  attention  without  my  head  swimming, 
and  complete  exhaustion  after  a  two-mile  walk.  I  had 
hopes  that  I  should  throw  it  off,  but  after  thjxe  years 
it  stiU  clings  tenaciously  to  me,  although  I  am  better 
than  I  was.  No  drugs  seem  to  do  any  good."  Yet 
another,  this  time  a  middle-aged  woman,  requires  help 
for  removal  of  fear  of  traveUing  ;  for  self-confidence  ; 
to  stop  shaking  of  limbs  ;  to  do  away  with  bitter,  [ealous 
and  suspicious   thoughts ;   to  remove   introspection,  to 


100     THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

"  clear  head  "  and  remove  "  contracted  feeling  " ;  to  give 
spirit  and  interest  for  life  and  work.  A  list  of  require- 
ments evidencing  the  tjrpe  of  neurasthenia. 

A  professional  man  writing  as  a  neurasthenic  of  sixteen 
years'  standing,  gives  the  following  history  :  "I  am 
neurotic,  of  neurotic  parents  ;  age  forty -nine — very 
nervous.  I  served  twenty-three  years  in  the  tropics,  and 
had  to  do  a  lot  of  railway  travelling,  and  that  ruined  my 
sleep.  Confined  with  anxious  work  during  the  day  and 
no  sleep  at  night,  my  health  broke  down,  and  I  had  to 
come  home.  I  cannot  stand  a  cold  bath.  I  have  atonic 
dyspepsia,  and  have  had  weak  digestion  all  my  life." 

Here  is  the  story  of  a  young  man  who  has  been  ill  for 
some  years  with  "  almost  every  nervous  symptom  one 
could  mention."  He  has  no  power  of  "  concentration," 
and  is,  therefore,  unable  to  read  for  long.  After  attend- 
ing closely  to  anything  he  gets  an  "  intense  feeling  with 
jumpy  heart  "  and  a  sensation  that  he  is  about  to  lose 
consciousness.  Even  a  conversation  is  sufficient  to 
bring  on  these  feelings.  Attacks  of  palpitation  in  which 
his  heart  "  hammers  away,"  with  shivermg  and  feeling 
of  apprehension,  add  to  his  burden.  The  history  of  this 
case  from  early  years  is  typical  of  that  of  many  neuras- 
thenics. As  a  child  he  was  very  "  nervy,"  but  seemed 
to  grow  stronger  for  a  time.  In  youth  his  inborn  nerv- 
ousness began  to  be  more  troublesome.  The  attempt  to 
take  up  useful  work  brought  out  his  limitations,  so  that 
only  a  few  hours'  attention  to  business  was  possible  each 
day.  Then  followed  a  series  of  "  rests  "  and  "  cures  "  in 
various  places  and  under  various  speciahsts.  Drugs, 
massage,  electricity,  nm'sing  homes,  hospitals,  con- 
valescent homes,  were  all  tried  in  turn  and  in  various 
combinations.  Resort  was  then  had  to  a  meatless  regime, 
in  which  a  forlorn  hope  was  made  to  sustain  nerve 
energies  on  a  dietary  in  which  such  things  as  "  puffed 
rice,"  "  grape  nuts  with  a  little  honey,"  and  "  twelve 
lightly   boiled  raisins  "   seem    to   have   figured  promi- 


THE  NEURASTHENIC  STATE  101 

nently.  At  the  age  of  twenty-five  he  was  found  still 
seeking  a  purely  physical  remedy,  making  no  effort  to 
use  his  own  will  power,  and  not  at  aU  pleased  at  being 
told  that  the  cure  for  his  troubles  was  to  be  sought  in 
mind  rather  than  in  matter. 

A  clerk  of  delicate  appearance  complains  of  "  nervous 
attacks,"  in  which  he  becomes  cold  and  shivering,  with 
perspiring  palms.  He  has  had  poor  health  lately  ;  his 
digestion  has  been  bad,  and  sore  throat  has  bothered 
him.  In  these  circumstances  the  nervous  attacks  coming 
on  suddenly  at  the  slightest  jar  or  shock — for  example, 
if  in  a  train  which  has  stopped  unexpectedly — ^have  been 
particularly  distressing.  Here  the  over- worked,  ill- 
nourished  state,  and  anxious  temperament  give  obvious 
clues  for  the  lines  on  which  treatment  must  be  carried 
out. 

A  man  between  fifty  and  sixty  years  of  age  says  that 
he  has  suffered  from  neurasthenia  for  nearly  twenty 
years  ;  qualifying  this  by  adding  that  he  gets  spells  of 
good  health  between  the  attacks.  Attributing  the  onset 
of  his  symptoms  to  the  loss  of  a  near  relative,  he  gives  a 
list  of  present  troubles  which  include  constant  sense  of 
apprehen-sion — "  fear  of  everything  "  ;  disturbed  sleep  ; 
neuralgic  pains  ;  constipation  and  loss  of  appetite  ; 
worrying  thoughts  and  depression  which  he  cannot 
throw  off.  Inquiry  shows  that  his  present  state  of 
lowered  nerve-tone  follows  special  anxiety  in  connection 
with  his  financial  affairs. 

A  man  of  some  thirty-five  years  of  age  says  :  "  All  my 
life  I  have  had  some  nerve  disorder  or  trouble  connected 
therewith,  but  I  am  unable  to  get  much  benefit  from 
doctors,  although  I  have  consulted  several."  Without 
venturing  to  make  it  clear  why  he  should  nevertheless 
have  decided  to  consult  yet  another,  he  describes  the 
following  distressing  symptoms  :  "  Irritation  of  stomach," 
head  troubles,  unpleasant  sensations  as  if  being  struck 
in   various    parts    of    the    body,   digestive    discomforts, 


102  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

which  he  describes  with  more  regard  for  accuracy  of 
details  than  for  the  feelings  of  his  auditor,  (He  illus- 
trates that  morbid  dwelling  on  symptoms  with  uncon- 
scious exaggeration  displayed  by  some  invahds,  who  are 
inclined  to  rely  more  and  more  on  their  own  exhaustive 
studies  of  neurasthenia  than  on  the  advice  of  those 
whose  experience  is  really  valuable  ;  it  is  always  well  to 
point  out  to  such  as  kindly  as  possible  that  whilst  he 
bases  his  knowledge  on  one  case  of  neurasthenia — his 
own — the  doctor  advises  from  an  experience  of  many.) 

Yet  another  man  still  on  the  right  side  of  forty  relates 
a  story  of  some  fifteen  years'  varying  health.  He  writes 
that  his  symptoms  began  with  "  a  general  slackness 
felt  chiefly  on  waking  in  the  morning,  and  the  alimentary 
business  got  upset — I  used  to  get  a  lot  of  flatulence  and 
a  dirty  tongue.  These  attacks  used  to  pass  off  with  the 
help  of  a  tonic.  About  six  years  ago  I  began  to  get 
another  symptom  coming  with  the  attack — an  upsetting 
of  the  heart's  action.  This  came  on  two  hours  or  so  after 
violent  exertion.  About  this  time  I  began  to  feel  tired 
with  severe  exercise.  My  condition  got  rather  chronic, 
and  I  had  a  regular  breakdown.  I  got  then,  and  I  get 
now  at  times,  what  seems  to  be  a  kind  of  nerve  storm. 
My  face  flushes  and  my  hands  go  cold,  and  I  get  a  nasty 
sensation  about  the  stomach.  The  heart  sometimes 
thumps,  but  generally  goes  weak  and  I  feel  faint.  Brandy 
always  reheves,  but  I  do  not  want  to  take  this.  Whilst 
the  attack  lasts  I  am  very  irritable.  I  am  not  depressed 
or  seemingly  nervous  at  all,  but  these  things  incapaci- 
tate one  from  getting  the  best  out  of  life." 

After  some  jT^ears  of  ill-health,  including  several  opera- 
tions, a  lady  writes  to  say  that  she  finds  her  powers  of 
self-control,  memory  and  mental  grasp  are  considerably 
impahed.  "  I  get  very,  very  easily''  irritated  and  put  out  " 
— "  I  tried  to  use  self-control  and  make  up  my  mind  to 
do  so,  but  when  the  time  comes  I  absolutely  seem  not 
to  be  able  to  remember  my  resolution  or  have  power  to 


THE  NEURASTHENIC  STATE  103 

carry  it  out.  1  also  get  very  apprehensive,  and  inclined 
to  worry  over  past  failures.  I  have  longed  for  some 
sort  of  treatment  or  help  to  enable  me  to  make  a  real 
start." 

The  following  tortuous  account  of  disordered  sensa- 
tions shows  how  the  same  process  of  introspection  and 
endeavour  to  find  a  basis  for  mental  discomfort  leads  to 
an  environment  of  thought  that  absorbs  the  whole  time 
and  interest.  In  this  case  the  sufferer  was  perfectly  sane, 
but  entirely  concentrated  on  his  troubles.  About  these 
he  writes  :  "I  feel  sure  I  have  at  last  put  my  hand  at  the 
root  of  the  trouble — ^the  cause  of  all  the  irritations  I  have 
every  day  ;  and  I  want  to  put  it  to  you  that  the  whole 
thing  is  practically  aU  physiological  and  not  psychical.  I 
feel  sure  now  that  the  trouble  is  due  to  the  state  or 
physical  condition  of  the  brain  or  nerves  ;  and  I  will 
give  you  my  reasons  for  this  conclusion.  Every  irritating 
thought  and  feeling  is  accompanied  with  a  physical 
sensation — either  of  a  very  minute  character  as  the 
slightest  touch  of  a  pin's  head,  or  else  in  a  greater  degree 
as  of  pressure  on  a  nerve.  The  physical  sensation  can 
in  general  be  classed  in  two  divisions :  (1)  In  a  mild 
degree  as  irritation,  (2)  in  an  acute  degree  as  pressure  ; 
but  for  the  present  purpose  I  will  always  refer  to  this 
sensation  as  irritation.  There  is  a  vital  point,  namely, 
that  whenever  I  have  this  irritation  (except  when  very 
slight)  the  brain  is  obviously  to  myself  not  working 
prox:)erly — or  better,  perhaps,  is  not  co-ordinating.  And 
certainly  when  the  irritation  is  bad,  the  Ego  seems  quite 
disconnected  from  the  brain  and  has  no  influence  for  the 
time  being."  The  whole  point  of  this  rigmarole  is  an 
endeavour  to  explain  the  extreme  discomfort  of  nem'as- 
thenia  in  a  particular  instance.  Always  a  Httle  know- 
ledge is  a  dangerous  thing,  but  hardly  ever  more  so  than 
when  the  victim  of  nervous  disorder  endeavours  to  sort 
out  his  symptoms.  When  he  will  remember  that  neuras- 
thenia is  the  great  malady  of  disordered  sensation,  and 


104     THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

realizes  that  it  is  useless  as  well  as  a  hopeless  task  for 
him  to  try  and  fit  his  physical  feelings  to  supposed 
physical  foundations,  he  will  take  a  good  step  forward 
towards  recovery.  To  attempt  analysis,  to  try  and 
worry  the  thing  out,  only  leads  to  more  and  more  intro- 
spection and  ultimately  to  confusion  worse  confounded. 

An  over-worked  professional  man  writes  :  "  My 
present  physical  symptoms  are  as  follows  :  Constant 
flatulence,  dyspepsia,  this  occasionally  gives  rise  to  acute 
attacks  of  gastric  distension,  causing  severe  palpitation 
of  the  heart,  and  great  terror,  which  I  cannot  get  rid  of. 
In  so  far  as  the  terror  is  associated  with  an  idea  it  seems  to 
be  a  fear  of  sudden  death.  I  occasionally  when  alone  get 
attacks  of  terror  without  palpitation  and  with  no  defi- 
nite associa,ted  idea — but  generally  I  do  not  get  beyond 
uneasiness  and  apprehension.  I  have  lost  a  good  deal  of 
flesh — my  heart  is  very  irritable  and  '  runs  away  '  at  the 
least  nervous  excitement.  A  pretty  sharp  attack  was 
occasioned  about  a  jeaY  ago  by  the  guns  at  a  firework 
representation.  Apart  from  physical  symptoms  of  indi- 
gestion, loss  of  weight,  etc.,  I  suffer  from  a  good  deal  of 
depression,  but  most  of  all  from  most  unrear^onable  fears. 
I  am  always  obsessed  by  a  fear  of  sudden  death.  I  am 
very  anxious  when  I  am  left  alone  in  the  house  and  am 
quite  unable  to  travel  or  even  to  go  out  alone.  It  is  not 
exactly  a  fear  of  being  alone,  but  a  fear  of  being  taken  ill 
whilst  there." 

A  man  of  middle-age  described  his  troubles  as  "  the 
sensation  of  a  threatened  loss  of  consciousness,  which 
comes  over  me  every  few  minutes,  lasting  a  second  or  so. 
This  is  continuous.  I  have  been  affected  in  this  way  for 
a  very  long  time.  I  never  actually  go  unconscious,  but 
feel  almost  on  the  verge  of  it  sometimes.  I  have  been 
told  that  I  have  a  dilated  stomach,  and  I  wish  particu- 
larly to  emphasize  that  there  are  constant  rumbling 
noises  about  the  stomach,  and  if  I  press  my  fingers  there 
these   noises   continue.      One   doctor   has   suggested   an 


THE  NEURASTHENIC  STATE  105 

operation  for  this,  in  order  to  widen  the  passage  from  the 
stomach  to  the  bowels.  Further,  I  have  a  great  deal  of 
flatulence.  Again,  I  would  point  out  that  the  circulation 
appears  to  be  very  poor  indeed — hands  and  feet  being 
almost  cold  with  hands  often  blue — and  sometimes  one 
portion  of  a  limb  will  be  cold.  I  am  also  very  nervous 
and  startled  with  the  slightest  noise,  and  sometimes 
wonder  whether  the  nerves  of  the  stomach  are  defective 
as  any  startling  noise  seems  to  affect  the  stomach  first. 
I  have  consulted  several  medical  men,  and  on  advice  I 
have  had  teeth  replaced  by  artificial  ones  and  have  had 
eyes  examined  and  fitted  vdth  spectacles." 

Another  neurasthenic  sufferer  says  :  "  The  periods  of 
weakness  and  depression  which  have  characterized  my 
illness  began  first  ten  or  twelve  years  ago.  The  first 
following  a  very  bad  attack  of  influenza.  At  first  they 
only  came  at  fairly  long  intervals,  but  within  the  last 
five  years  I  have  had  two  other  severe  attacks  of  infiuenza 
and  the  prostration,  insomnia,  and  depression  have  been 
so  much  worse  and  have  necessitated  giving  up  my  work. 
About  two  and  a  half  years  ago  I  had  a  nasty  fright,  and 
since  then  I  have  suffered  very  much  from  depression 
and  all  sorts  of  nervous  fears  with  bad  spells  of  insomnia." 

Histories  such  as  the  above  show  that  neurasthenia  is  a 
disease  of  disordered  function  ;  an  exhaustion  of  nerve- 
centres  and  a  weakening  of  thought-control  opening  the 
way  to  a  breakdown — or  at  best  a  serious  incapacitation 
— of  various  vital  functions  and  including  diminished 
brain-power.  At  the  same  time,  one  notes  that  we  have 
here  a  malady  prohfic  in  heightened  and  disturbed  sensa- 
tion. Discord  in  both  function  and  sensory  reaction 
combine  to  cause  these  discomforts  and  illness  that  are 
so  graphically  described  by  those  they  trouble,  who  find 
words  fail  them  to  express  their  symptoms  accurately. 
Often  enough  one  has  heard  neurasthenic  people  derided  for 
the  care  and  wealth  of  detail  mth  which  they  describe  their 
difficulties.    This  is  unfair  to  them,  because  the  supposed 


106  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

selfishness  on  which  this  condition  is  based  in  itself  a 
symptom  of  the  nervous  state.  It  is  the  effort  to  get  at  the 
bottom  of  his  troubles  that  turns  the  invalid's  thoughts 
more  and  more  inwards,  and  leads  to  those  prolonged 
self-analyses  and  expression  in  those  closely  written 
notes  and  lengthy  narratives  with  which  he  is  so  often 
armed ;  or  in  many-paged  descriptions  of  symptoms  with 
which  an  endeavour  is  made  to  assist  his  doctor's  quest 
for  the  som-ce  of  his  ill-health.  Those  who  spurn  the 
personal  stories  of  nervous  people  frequently  in  so  doing 
pass  over  the  very  information  that  holds  the  key  to  the 
individual's  problem.  Both  patient  and  those  who  would 
help  him  only  too  often  lose  their  way  in  a  forlorn  pursuit 
after  physical  causes.  The  former  analyses,  describes, 
writes  and  rewrites  his  story  with  a  steady  attention  to 
minutiae  that  is  intended  to  reveal  the  full  waywardness 
of  heart,  appendix,  stomach,  brain,  or  whatever  organ 
he  feels  must  be  "to  blame  for  the  whole  thing."  Whilst 
the  doctor,  relying  on  his  methods  of  physical- diagnosis, 
may  pay  little  heed  to  the  written  narrative  which  usually 
contains  the  psychological  clue  to  the  situation.  True 
enough,  there  is  a  school  to-day  that  encourages  accounts 
of  thoughts,  feelings  and  even  dreams  to  an  extent  that 
may  well  be  emba^rrassing,  but  its  followers  are  few  enough, 
and  one  has  rather  in  mind  the  task  of  the  practitioner 
who  wishes  to  maintain  a  level  of  common-sense,  and 
estimate  judiciously  both  physical  and  psychological 
factors.  In  neurasthenia  above  all  illnesses  it  is  wise  and 
just  to  attend  carefully  to  the  invalid's  own  story.  One 
should  do  so  if  only  to  point  out  fallacious  suppositions 
and  erroneous  deductions.  The  only  way  to  free  people 
from  a  network  of  crippling  sensations  is  to  show  them 
how  and  where  they  can  break  their  bonds  by  under- 
standing the  true  facts  of  the  case. 


CHAPTER  III 

MORBID   FEARS  AND   DOUBTS 

Obsessions  —  Psychastheiiia  —  Obsessional  neiu'asthenia  —  Webster's 
definition  of  "  obsession  " — Common  forms  of  obsessional  thoughts 
— Morbid  fears — -Their  physical  accompaninaents — Agoraphobiti — 
Claustrophobia — Siderophobia — Anthropophobia — Morbid  flushing 
and  self-conscioasness — Pathophobia — Astrophobia — Batophobia — 
Fears  about  health — Morbid  anxieties — Doubts  and  scruples — 
Over-conscientiousness — Fear  of  impulsive  action — Some  examples. 

THERE  is  a  particular  type  of  neurasthenic  state 
which  requires  special  consideration  in  that  it  is 
characterized  by  special  mental  difficulties.  In  addition 
to  the  mental  fatigue  and  depression  common  in  neuras- 
thenia the  form  of  disorder  in  view  always  exhibits  ob- 
sessions ;  that  is  thoughts  and  ideas  which  continually 
recur  and  will  not  be  dismissed.  Of  such  a  kind  as  by 
their  nature  or  persistence  seriously  to  disquiet  those 
bothered  with  them,  they  end  by  dominating  every  other 
interest.  Their  victim  thereby  becomes  preoccupied,  is 
unable  to  work  properly,  and  wastes  a  vast  amount  of 
nerve-energy  in  combating  his  obsessions. 

Owing  to  this  some  observers  now  write  and  speak  of 
psychasthenia  as  opposed  to  neurasthenia,  by  this  term 
indicating  people  who  from  earliest  years  have  shown 
signs  of  nervous  disposition.  At  the  outset  excitable 
and  suffering  from  night  terrors  or  other  neuroses  of 
childhood,  they  later  enter  the  class  of  dreamy,  delicate 
yet  inteUigent  boys  and  girls  who  in  one  way  or  another 
commonly  are  a  source  of  anxiety  to  parents  and  others  ; 
in  adolescence  they  begin  to  evince  more  definite  signs  of 
instability  ;    in  adult  life  they  are  often  ailing  though 

107 


108  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

rarely  ill,  and  all  the  time  harassed  by  a  ceaseless  ever- 
changing  series  of  nervous  difficulties  which  their  inborn 
sensitiveness  and  emotionalism  make  it  hard  for  them 
to  fight  successfully.  These  indeed  are  the  so-called 
"  psychasthenics."  But  obsessions  may  bother  anyone 
whose  nerves  get  out  of  order,  and  by  their  appearance 
only  one  cannot  define  psychasthenia.  For  the  rest  it  is 
a  matter  of  degree,  and  although  future  observation  may 
persuade  us  to  split  up  "  neurasthenia  "  into  sub-groups 
there  is  scarcely  yet  sufficient  ground  for  so  sharply 
separating  psychasthenia  as  some  would  do.  For  one's 
notes,  or  as  a  convenience  in  indicating  predominance 
of  symptoms,  it  may  be  useful  to  make  a  sub-heading 
of  "  obsessional  neurasthenia,"  but  such  should  only  be 
used  when  it  is  clearly  understood  not  to  exclude  the 
coincidence  of  other  common  disorders — subjective  sen- 
sations and  so  forth — with  the  obsessions,  in  the  particu- 
lar instances  thus  kept  in  a  separate  file  or  note-book. 

Obsessing  thoughts  are  of  all  kinds,  from  little  haunting 
phrases  and  questions  to  tormenting  ideas  that  seriously 
influence  their  victim's  life.  Few  there  are  who  have  not 
on  occasion  been  troubled  with  a  curious  feeling  of  being 
compelled  to  carry  out  some  little  act.  Frequently  the 
triffing  thing  is  done,  and  no  more  thought  about  it. 
Less  hardy  thinkers  admit  an  element  of  fear  with  the 
compulsion,  and  once  they  do  so  the  impulsive  tendency 
becomes  accentuated.  How  foolish  it  seems  to  want  to 
touch  a  lamp-post,  or  kick  a  particular  stone  or  move  a 
pair  of  boots  ;  especially  when  the  want  is  felt  so  strongly 
that  to  resist  it  causes  real  mental  discomfort.  To  realize 
this  funny  side  of  the  impulse,  to  give  way  and  to  laugh, 
indeed,  will  take  away  its  sting.  To  resist,  to  fear,  and 
finally  to  give  way,  is  to  submit  to  a  sad  tyranny.  One 
may  not  be  able  to  give  way  when  the  impulse  points  to 
danger,  but  one  can  always  laugh,  and  ridicule  is  the 
best  treatment  possible  for  a  haunting  thought.  Many 
who  think  they  know  not  "  nerves  "  become  anxious  as 


MORBID  FEARS  AND  DOUBTS  109 

soon  as  they  find  themselves  at  the  edge  of  a  tall  cliff,  or 
on  the  roof  of  a  house,  or  walking  on  a  high  bridge,  lest 
they  be  impelled  to  throw  themselves  over.  However, 
those  thus  bothered  with  impulsive  thoughts  may  take 
comfort  in  the  knowledge  that  in  face  of  laughter  the 
impulse  commonly  loses  its  significance.  See  it  in  its 
true  light,  reahze  the  power  of  Will  and  the  thing  loses 
its  terror. 

Webster  defines  an  obsession  "  as  the  persistent  and 
unescapable  influence  of  an  idea  or  emotion  "  ;  ^  that 
exactly  expresses  the  relation  of  the  tormenting  thoughts 
in  neurasthenia  to  their  victims.  All  day  long  the  sufferer 
is  haunted  by  their  presence  ;  however  he  occupies  him- 
self there  just  in  the  background  of  his  mental  field  are 
the  tiresome  ideas.  It  may  be  noted  that  the  term 
obsession  is  derived  from  two  Latin  words  together 
meaning  to  sit  upon.  Truly  obsessions  sit  upon  those 
they  attack,  one  of  the  most  unpleasant  features  of 
these  trying  thoughts  being  that  the  more  one  fights 
against  them  the  more  firmly  do  they  maintain  their  seat  ; 
the  more  seriously  they  are  taken  the  more  do  they  puff 
themselves  up.  If  one  traces  them  back  in  any  particu- 
lar case  it  is  nearly  always  found  that  they  had  small 
beginnings  ;  sometimes  coming  suddenly,  but  as  a  rule 
without  much  force.  Subsequently  the  neurasthenic 
realizes  that  the  same  thought  has  been  bothering  him, 
and  often  it  is  the  shock  due  to  fear  lest  he  may  not  be 
able  to  get  rid  of  it  that  actually  establishes  the  obsession. 
The  persistence,  intensity,  and  personal  character  of 
common  obsessing  thoughts  is  such  as  to  excuse  a  less 
educated  generation  in  supposing  that  they  were  im- 
planted in  human  minds  by  evil  spirits.  In  those  days 
the  term  obsession  had  a  more  sinister  meaning  than 
that  which  we  now  ascribe  to  it,  and  many  a  man  of  weak 
nerve  suffered  terrible  misery  from  the  added  fear  that 
he  was  in  the  grip  of  dark  forces. 

^  Webster's  New  International  Dictionary. 


110  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

As  a  matter  of  practical  experience  obsessions  com- 
monly follow  certain  familiar  lines,  and  at  once  it  may 
be  noted  that  they  can  be  readily  classified  under  the 
headings  of  fears,  doubts,  scruples,  haunting  phrases,  or 
questions  and  impulses.  Of  these  the  morbid  fears  and 
doubts  are  by  far  the  most  common.  Scruples  have,  of 
course,  been  a  source  of  psychological  discussion  for 
centuries,  and  used  to  be  considered  a  matter  rather  for 
the  priest  than  the  physician.  To-day  the  individual 
who  finds  his  conscience  troubling  him  about  trifles  often 
realizes  that  his  nerves  may  be  out  of  order,  although 
there  are  still  many  people  going  to  the  confessional  who 
ought  to  be  going  to  the  consulting-room.  Let  us  then 
consider  in  some  detail  the  nature  and  conseq4iences  of 
these  obsessing  thoughts,  taking  the  morbid  fears  first 
of  all. 

At  once  it  must  be  noted  that  these  compelling  fears 
or  "  phobias,"  so  commonly  met  with  as  an  accompani- 
ment of  nervous  instability,  work  in  the  brain  indepen- 
dently of  reason.  However  much  their  victim  knows, 
and  confirms  his  knowledge  by  reasoning,  that  there  is  no 
ground  for  his  fear,  nevertheless  when  it  comes  upon  him 
he  is  swept  along  like  chaff  before  the  wind.  In  the  calm- 
ness of  his  study  he  reasons  out  the  baselessness  of  his 
fear,  and  feels  that  he  can  conquer  it.  Sadly  enough, 
when  the  thing  he  has  greatly  feared  comes  upon  him 
reason  gives  way  to  panic  ;  a  nerve-storm  breaks  up  the 
tranquillity  of  his  steady  calm,  and  deadly  fear  possesses 
his  pulses.  With  thumping  heart,  hastened  breath,  and 
sweating  palms,  he  is  for  the  nonce  turned  into  the  sem- 
blance of  a  shivering  poltroon.  The  agony  oi  mind 
suffered  by  men  and  women  of  strong  moral  fibre,  who, 
far  from  cowards  at  heart,  yet  are  habitually  overcome 
by  specific  fear  storms,  is  great  indeed.  In  the  presence 
of  the  things  feared  the  very  fiood-gates  of  unreasoning 
terror  are  let  loose,  and  calm  judgment  is  swept  away  in 
the  torrent. 


MORBID  FEARS  AND  DOUBTS  111 

There  are  many  nervous  dreads  or  phobias  characteristic 
of  the  neurasthenic  state.  Thus,  wide  spaces  are  a  hete 
noire  to  many,  in  the  sense  that  being  out  in  the  open 
renders  them  liable  to  that  particular  morbid  panic  we 
term  agoraphobia.  It  is  named  agoraphobia,  indeed,  only 
because  it  has  become  customary  to  give  these  fears  high- 
sounding  titles  compounded  out  of  Greek  names  indicat- 
ing the  things  feared  and  the  idea  of  fear  itself.  The 
agoraphobic  person,  indeed,  fears  greatly  the  field  or 
the  wide  market  place.  To  suffer  in  this  way  means 
that  outside  the  house  there  is  no  peace  of  mind  except 
in  crowded  streets  and  narrow  roads.  Under  such 
conditions,  the  crossing  of  a  wide  space  is  always  an 
escapade,  and  a  walk  in  the  country  an  impossibility, 
the  mere  thought  of  whida  occasions  mental  distress. 
Every  visit  to  a  strange  place  puts  the  victim  of  this  fear 
on  tenterhooks  lest  he  shall  precipitately  be  faced  with 
the  crossing  of  an  open  space.  No  invitation  can  be 
accepted  until  the  ground  has  been  prospectively  sur- 
veyed by  many  a  furtive  question  and  much  diligent 
inquiry.  The  confirmed  victim  of  agoraphobia  becomes 
an  expert  on  the  face  of  the  landscape.  He  knows  he  can 
play  golf  at  one  place  because  the.  course  is  secluded  and 
overshadowed  with  many  trees,  or  broken  by  natural 
features  that  interrupt  its  spacioueness,  but  he  has  a 
dozen  others  on  his  black  list  as  places  where  the  wide 
sweep  of  ground  spells  for  him  nothing  but  misery. 

But  in  this  matter  of  obsessional  fears  conditions 
favourable  to  one  man  mean  acute  anxiety  for  others. 
Thus  the  sense  of  space  so  shunned  by  the  agoraphobic 
is  welcomed  by  him  who  fears  morbidly  all  closed  spaces. 
The  narrow  street,  or  the  small  room  which  brings  balm 
to  the  one  brings  unrest  to  the  other.  Claustrophobia, 
the  fear  of  closed  spaces,  is  indeed,  the  second  of  the 
two  most  common  morbid  terrors,  and  in  some  respects 
it  is  a  far  greater  handicap  than  its  fellow.  After  all, 
most  of  the  day's  work  can  be  got  through  quite  com- 


112     THE  PROBLEM  OF  NERVOUS  BREAKDO\VN 

fortably  without  wide  spaces  having  necessarilj'  to  be 
negotiated,  but  life  in  big  cities  is  largely  a  matter  of 
living  amongst  crowds  in  smallish  rooms,  whilst  when 
moving  from  place  to  place  one  goes  through  a  maze  of 
tubes  and  tunnels,  lifts  and  passages  that  of?er  conditions 
most  appalling  to  claustrophobic  people.  When  no  journey 
can  be  decided  upon  until  the  possibility  of  tunnels  has 
been  prospected  ;  when  the  use  of  a  lift  has  to  be  avoided 
on  every  possible  pretext ;  when  to  travel  on  the  Under- 
ground is  always  a  perilous  venture,  and  when  no  ticket 
can  be  taken  for  a  pubhc  entertainment  until  the  seat 
it  gives  is  known  to  be  situated  near  the  door,  life  has  an 
added  complexity  that  is  a  serious  handle  aj). 

Another  common  fear  causes  its  victim  to  think 
twice  before  taking  a  railway  journey.  Dignified  by  the 
name  siderophobia,  it  is  often  so  intense  as  to  prevent 
people  for  years  at  a  time  from  going  far  from  their 
homes,  the  morbid  dread  of  railway  traveUing  most 
certainly  ranks  as  a  serious  manifestation  of  nervous  dis- 
order. As  it  is  a  curious  circumstance  about  the  fear  of 
open  spaces  that  sometimes  those  hampered  by  it  will 
cross  a  square. or  field  or  common  when  in  company  of 
some  one  else  or,  indeed,  at  times  even  when  possessed  of 
a  stick  or  umbrella,  or  preceded  by  a  dog,  so  is  it  the  case 
with  those  afraid  of  trains  that  the  presence  of  someone 
else  in  the  compartment  will  for  the  time  being  take  away 
their  panic.  On  the  other  hand,  there  comes  to  mind  an 
extreme  instance  in  which  a  nervous  individual  having 
to  keep  an  important  engagement  some  thirty  miles  away 
was  so  far  unable  to  spend  an  hour  in  the  train  as  to  have 
to  plan  out  an  adventurous  journey,  in  which  by  cycle, 
motor-bus,  tram  and  taxi-cab  he  succeeded  in  accom- 
plishing his  purpose,  and  at  the  same  time  evading  the 
dreaded  railway.  A  few  miles  on  a  bicycle  took  him  to 
the  terminus  of  a  motor-bus  route ;  then  fifteen  miles  on 
the  road  brought  him  mthin  reach  of  a  tramway  service  ; 
a  long  and  weary  journey  in  a  succession  of  trams  landed 


MORBID  FEARS  AND  DOUBTS  113 

the  patient  traveller  at  a  stand  for  taxi-cabs ;  thence  he 
concluded  the  Journey  in  dignified  haste.  Nothing 
daunted  by  the  fatigue  and  discomfort  of  his  strange 
passage,  and  beyond  reach  of  persuasion  that  he  should 
return  by  train,  this  unfortunate,  victim  of  obsessing 
fear  reversed  his  method  of  travel,  and  ultimately  arrived 
home  none  the  worse  for  the  adventure.  The  knowledge 
that  some  people  are  constantly  having  these  experiences 
leads  one  to  see  how  far  Hfe  can  be  carried  on  without 
trains,  for  example,  and  it  is,  indeed,  interesting  to  note 
what  a  long  way  it  is  possible  to  go  without  using  the 
railway  at  all  so  long  as  one  is  a  patient  observer  of  road- 
way services,  a  cyclist,  and  withal  not  afraid  of  a  few 
miles  on  foot  to  complete  a  necessary  connection  here 
and  there.  It  might  be  supposed  that  the  convenience 
of  being  free  from  such  fears  would  determine  every  one 
who  is  bothered  by  them  to  give  up  hours,  weeks,  or 
even  months  to  that  patient  mental  re-education  and 
self -training  which  wiU  invariably  minimize,  where  it  will 
not  drive  away,  the  morbid  dread.  Strange  to  say,  the 
majority  are  too  pessimistic  about  their  difficulty  to  set 
out  seriously  upon  the  path  of  self -treatment.  Neverthe- 
less, there  is  probably  no  obsessional  fear  that  will  not 
yield  to  perseverance  and  patient  training  of  thought  in 
the  right  way. 

Nervousness  in  the  presence  of  other  people  sometimes 
acquires  the  character  of  an  obsessional  fear.  Brought 
into  line  with  the  rest  under  the  name  of  anthropophobia 
it  drives  its  victim  into  solitude,  and  is  responsible  for 
some  of  those  curious  instances  of  hermitage  v/hich 
interest  the  public  from  time  to  time.  In  less  degree,  it  is 
often  the  cause  of  that  morbid  blushing  and  flushing 
which  so  very  much  distresses  sensitive  people.  Here 
there  is  usually  a  mixture  of  extreme  self-consciousness 
and  sense  of  uneasiness  in  the  presence  of  other  people  ; 
the  two  things  having  a  different  psychological  basis, 
but  working  together  towards  the   same  end,  namely 


114  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

that  those  troubled  by  them  labour  under  the  false  im- 
pression that  everyone  is  looking  at  them  or  that  they 
have  some  peculiarity  of  expression  that  attracts  atten- 
tion. Morbid  flushing  is  very  common  among  abnormally 
sensitive  people,  whilst  quite  a  number  of  nervous  persons 
suffer  miseries  from  false  beliefs  that  their  eyes  are 
pecuhar,  their  expressions  strange,  their  noses  not  quite 
straight,  or  their  appearance  in  some  way  bizarre.  Many 
of  these  spend  a  good  deal  of  time  going  round  to  ophthal- 
mic surgeons  and  oculists  in  an  endeavour  to  obtain  some 
form  of  spectacles  that  will  either  hide  or  correct  the 
supposed  curious  expression.  Nothing  but  a  full  under- 
standing that  the  whole  thing  is  based  on  a  morbid  mis- 
conception will  free  them  from  their  troubles. 

Dread  of  catching  some  infectious  disease  or  developing 
a  deadly  illness — pathophobia — obsesses  not  a  few.  When 
in  full  possession  this  phobia  affects  conduct  to  such  an 
extent  that  those  influenced  by  it  may  fear  to  shake  hands 
with  their  friends.  Often  they  refuse  to  handle  letters 
lest  they  may  have  come  from  an  infected  household  ; 
and  suffer  agonies  of  mind  in  pubhc  conveyances  lest 
fellow  passengers  should  be  disseminatmg  the  seeds  of 
disease.  They  wiU  not  go  within  a  mile  of  a  hospital,  and 
they  are  quite  ready  to  remove  from  their  Ust  of  ac- 
quaintances anyone  who  has  lately  suffered  from  one  of 
the  common  infections,  or  even  has  been  in  contact  to 
the  second  and  third  removed  with  a  friend  or  relative 
who  has.  This  is  a  phobia  not  very  different  from  that 
in  which  a  morbid  dread  of  having  unclean  hands  leads 
its  victim  to  be  constantly  washing,  and  having  washed  to 
wash  yet  again,  until  the  day's  routine  becomes  largely 
a  matter  of  ablution. 

Fear  of  thunder  and  lightning,  sometimes  caUed  astro- 
phobia,  and  batophobia,  fear  that  ceilings  will  come 
down  or  otjier  high  things  faU,  are  both  forms  of  nervous 
dread  which  one  comes  across  from  time  to  time.  The 
latter  is  matched  by  the  still  more  common  anxiety  that 


MORBID  FEARS  AND  DOUBTS  115 

the  individual  may  fall  from  exalted  places  such  as 
bridges,  cliffs  or  even  railway-platforms.  Yet  again  we 
meet  with  a  host  of  nervous  dreads  touching  various  con- 
ditions and  circumstances  of  everyday  life.  Mice,  cats, 
insects,  or  other  animals  produce  acute  fear  in  some  over- 
sensitive people  ;  plants,  colours,  food  and  weather  all 
add  their  quota  to  the  list  of  phobias  which,  indeed, 
would  be  difficult  to  complete  in  that  the  final  and  morbid 
differences  of  temperament  responsible  for  these  reac- 
tions are  infinite  in  their  varieties.  Thus  a  whole  chapter 
might  be  written  about  the  fears  of  illness,  apart  from 
the  morbid  dread  of  infectious  disease  just  referred  to. 
Apjjrehension  with  regard  to  the  heart,  to  apoplexy, 
appendicitis,  tuberculosis,  and  other  not  uncommon  ills 
to  which  the  flesh  is  heir  haunt  some  nervous  people 
from  morning  till  night.  Persistently  translating  un- 
pleasant sensations,  which  really  have  but  the  shghtest 
significance,  into  signs  of  oncoming  disaster,  the  obsessed 
neurasthenic  may  make  his  own  life  and  that  of  his  rel- 
tives  unbearable.  Instead  of  accepting  the  ordinary 
accidents  and  happenings  of  life  as  the  lot  of  humanity 
in  this  present  phase  some  jDcople  of  nervous  tempera- 
ment display  their  tendencies  by  making  everything  into 
a  personal  matter,  and  thinking  that  every  untimely  event 
in  their  own  circle  must  needs  be  also  worked  out  for  them- 
selves. Many  people  of  nervous  temperament  complain 
of  feehngs  of  anxiety  about  the  most  trivial  things.  They 
are  tormented  all  night  with  anxious  thoughts  as  to 
whether  they  have  left  the  gas  on  in  some  part  of  the 
house,  or  as  to  whether  the  kitchen  fir©  is  safely  low, 
or  the  house  doors  are  securely  locked,  and  so  forth. 
Where  they  are  unable  to  break  free  from  their  petty 
worries  they  spend  time  and  money  in  telegraphing  and 
telephoning  and  sending  special  messages  to  satisfy 
themselves  as  to  whether  they  have,  or  have  not,  done 
certain  things  at  the  places  they  have  left.  This  sort  of 
thing  varies   only  in  degree  from  that  of   the  obsessed 


116  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

doubter  who  centres  his  mistrust  around  special  things, 
and  whose  difficulties  may  now  be  considered. 

Morbid  doubts  commonly  concern  things  of  religion  and 
conscience.  When  so  strong  as  to  become  obsessions 
they  influence  the  whole  life  and  conduct  of  their  victim 
just  as  do  the  phobias  just  discussed.  Expressed  in 
myriad  forms,  and  through  the  medium  of  lengthy 
human  documents,  they  can,  however,  nearly  always  be 
reduced  to  a  simple  term,  namely,  into  fear  lest  duty  has 
not  been  fulfilled  towards  self  and  others.  In  a  word, 
the  neurasthenic  doubter  suffers  from  a  morbid  over- 
conscientiousness  which  leads  him  to  parson  or  doctor 
according  to  his  bent,  and  frequently  to  both.  It  is 
characteristic  of  these  doubts  and  scruples  that  those 
who  suffer  from  them  are  so  under  the  influence  of  the 
morbid  idea  that  they  cannot  judge  correctly  about  it. 
The  difficulty  in  trying  to  help  them  is  that  there  is  often 
just  a  million-to-one  chance  that  their  doubt  has  some 
substantial  basis.  For  example,  a  man  tells  one  that  he 
has  just  carried  out  a  business  transaction  in  which  he 
has  gained  a  slight  advantage  which  might  not  have  been 
his  had  he  emphasized  a  particular  point  in  the  dealing. 
He  then  mentions  something  which  is  a  matter  of  common 
sense,  such  as  would  occur,  it  might  be  said,  to  every  one 
carrying  out  business  of  the  kind.  The  idea  has  fastened 
upon  our  conscience-stricken  friend  that  he  has  been 
very  unscrupulous,  and  he  is  now  suffering  torments  of 
remorse.  One  reassures  him  by  pointing  out  how  every 
man  of  the  world  would  naturally  have  taken  the  point  in 
doubt  into  consideration,  but  he  traverses  one's  argu- 
ments at  once  by  saying  "  Yes  ;  but  can  you  assure  me 
absolutely  that  no  one  would  overlook  it  ?  "  Obviously, 
one  cannot  truthfully  say  that  there  is  not  a  remote 
possibility  that  a  man  might  overlook  the  point,  and 
this  contingency  is  at  once  fastened  on  as  legitimate 
ground  for  doubt.  It  is  a  false  judgment,  of  course,  for 
the  healthy-minded  man  who  had  not  intended  to  take 


MORBID  FEARS  AND  DOUBTS  117 

advantage  of  his  fellow  would  shrug  his  shoulders  and 
say,  "Well,  it  is  his  look  out,  but  I  will  drop  him  a  line 
about  it."  Not  so  the  doubter,  who  continues  suffering 
agonies  over  his  supposed  unscrupulousness,  and  wdll 
not  clear  the  matter  up  by  going  and  having  a  straight- 
forward talk  with  the  other  man  because  he  fears  by  so 
doing  he  will  be  finally  branded  as  a  scoundrel.  The 
same  morbid  trend  of  reasoning  is  followed  by  those  who 
are  always  on  tenterhooks  lest  they  may  be  the  medium 
of  transmitting  infectious  disease  to  others.  Thus  a  man 
who  had  to  send  a  parcel  to  a  doctor  serving  with  the 
army  could  not  bring  himself  to  do  so  without  much 
apprehension  because  he  feared  that  in  handling  it  he 
might  convey  some  germ -laden  dust  or  dirt  thereto  and 
this  might  lead  to  the  poisoning  of  wounds  at  the  hands 
of  the  medical  man  to  whom  the  package  was  to  be  sent. 

Obsessed  by  apprehensions  about  fire  a  man  was  troubled 
with  a  particularly  bad  attack  of  doubt  under  the  follow- 
ing circumstances.  He  had  to  go  to  a  wedding  and,  think- 
ing his  silk  hat  was  not  smart  enough,  proceeded  to  polish 
it  up  with  some  petrol.  After  this  he  feared  to  take  it  up 
to  his  office  because  it  still  smelled  of  petrol  and  thought 
that  in  some  way  it  might  lead  to  a  fire  there.  As  illus- 
trating the  peculiar  limitations  of  some  obsessing  ideas, 
it  may  be  noted  that  in  this  instance  the  doubts  about 
fire  only  occurred  in  relation  to  this  man's  office.  Con- 
sequently, he  could  leave  the  petrolized  hat  at  home  with- 
out any  discomfort,  but  he  dared  not  take  it  to  the  city. 
Subsequently  questioned  as  to  his  "  fire  "  doubts,  he 
said  that,  although  improved  on  the  whole,  he  still 
had  to  pick  up  a  match  if  he  saw  it  at  the  door  of  the 
office.  Similarly  he  often  had  to  touch  the  switch  con- 
trolling the  current  of  his  electric  stove  to  make  sure 
that  it  was  really  turned  off  before  he  could  leave  for 
home.  Sometimes  having  got  home  in  the  evening,  he 
would  telephone  to  his  clerks  or  caretaker  asking  them  to 
make  sure  that  he  had  turned  off  the  switch. 


118  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

Doubts  about  promises  and  engagements  of  all  kinds 
are  a  constant  source  of  worry  to  predisposed  people,  A 
man  who  had  agreed  with  his  partner  to  have  three 
weeks'  holiday  wanted  to  return  home  a  little  earlier,  but 
dared  not  do  so  without  medical  authority  for  breaking 
what  he  took  to  be  an  important  promise.  In  an  attempt 
to  solve  his  difficulty  he  wrote  as  follows  :  "  Do  you 
think  I  ought  to  stay  in  honour  bound  until  next  Mon- 
day week,  or  would  I  be  as  well  at  home  ?  In  any  case, 
I  should  have  been  here  over  two  weeks  if  I  went  on 
Tuesday.  The  real  point  that  worries  me  is  as  to  whether 
I  actually  promised  to  stay  as  long  as  possible  or  not, 
and  if  I  did  so  am  I  bound  to  stay  until  Monday  week  ? 
I  have  an  idea  that  I  may  have  done  so,  but  also  think 
that  it  is  about  the  last  thing  I  should  have  done.  In  any 
case  there  would  be  no  harm  done  if  I  let  him  (the  part- 
ner) know.  The  length  of  time  was  usually  spoken  of  as 
three  weeks,  which  expires  on  Saturday  week.  I  am 
better  again,  but  not  quite  fit,  but  all  the  ideas  are  very 
silly  like  this  one.  You  must  wish  me  in  Jericho.  P.S. — 
I  do  not  want  to  feel  compelled  to  stay.  P.S.S. — Please 
assume  that  I  did  promise  to  stay  as  long  as  possible." 
Here  we  have  a  typical  epistle  with  doubt,  hesitation, 
and  over-conscientiousness  showing  in  every  line. 

The  following  story  speaks  for  itseH  :  "  Was  talking 
to  my  sister  last  night  about  being  so  sensitive  re  speaking 
the  exact  truth — or  she  was  teUing  me — at  any  rate,  she 
said  she  cm'ed  herself  by  saying  to  herself  '  Nobody  is  so 
particular,  so  why  should  I  be.'  Soon  afterwards  I  went 
to  my  sister's  house,  where  my  parents  were  dining,  and, 
although  my  mother  said  to  me,  '  We  shall  see  you  to- 
morrow,' to  which  I  could  easily  have  answered  '  Yes,'  my 
father  suddenly  said  to  me,  '  Are  you  going  to  the  concert 
to-morrow.'  I  had  very  little  time  to  think,  but  said, 
'  Aye,'  as  a  sort  of  mind  substitute  for  '  yes.'  Now  thia 
was  rather  a  lie,  because  I  had  not  made  up  my  mind  re 
Ascension  Day,  and  I  immediately  feared  that  one  of  my 


MORBID  FEARS  AND  DOUBTS  119 

horrible  ideas  would  appear,  but,  telling  myself  that  I 
did  not  fear  them,  or  something  of  that  sort,  they  did  not 
corq,e  in  any  violent  way,  and,  I  think,  not  at  all — any- 
how not  to  hurt.  I-  was  relieved  and  pretty  happy  again, 
but  the  whole  episode  came  again  to  my  mind  some 
minutes  later,  and  this  time  a  horrible  idea  did  come. 
It  worried  me,  because  it  was  founded  on  a  more  or  less 
lie.  But  I  see  that  the  whole  sin  was  saying  '  Aye  '  when 
I  did  not  really  know,  to  save  a  discussion  which  Ishould 
not  have  liked,  being  on  religious  matters,  and  that  the 
other  part  had  really  nothing  to  do  with  it,  and  that  if  I 
had  had  time  to  think  I  could  easily  have  said  something 
indefinite.  When  at  its  worst  my  morbid  mind  tells  me 
tha-;  I  preferred  avoiding  an  unpleasant  discussion  to 
avoiding  blasphemy.  [When  troubled  so-called  blas- 
phemous thoughts  would  flash  through  his  mind  and 
torment  him  with  sense  of  responsibility  for  them.]  I 
am  not  even  sure  that  I  anticipated  blasphemy,  so  short 
was  the  time.  I  did  not  sleep  well,  and  was  worried 
rather  badly  about  it — ^the  whole  thing  hinged,  of  course, 
or.  to-day  being  Ascension  Day." 

The  fate  of  the  nervous  doubter  is  to  be  continually 
swept  away  by  "  attacks  "  of  particularly  over-scrupu- 
lousness arising  from  various  incidents  of  everyday  life. 
He  gets  over  one  and  feels  a  little  better,  only  to  be 
caught  in  the  mazes  of  fresh  argument  in  a  few  days' 
time.  Well  may  many  a  sufferer  from  obsessions  exclaim 
with  Macbeth,  "  There  comes  my  fit  again.  .  .  .  Now  I 
am  cabined,  cribb'd,  confined,  bound  in  to  saucy  doubts 
and  fears. "^  Short  of  understanding  the  nature  of  the 
trouble,  and  re-educating  himself  so  as  to  be  able  to 
strike  at  the  root  of  the  whole  thing,  the  obsessed  indi- 
vidual may  be  troubled  and  haunted  with  these  dis- 
turbing thoughts  for  most  of  his  fife. 

Obsessions  may  be  further  illustrated  by  glancing  at 
the  chief  points  noted  in  a  series  of  case  records  taken 

1  Shakespeare's  Macbeth,  Act  III,  Sc.  4, 


120  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

haphazard  ;  in  these  the  following  morbid  fears  and 
doubts  have  been  emphasised :  Fear  of  impulsive  action, 
losing  control  or  of  "going  mad ;"  sense  of  panic  on  going 
far  from  home ;  on  getting  to  a  strange  place  is  obsessed 
by  feeling  that  he  must  get  back ;  songs  and  tunes  haunt- 
ing the  mind  every  evening  to  an  unbearable  extent, 
habits  as  to  touch  and  repeating  things ;  fear  of  travelling 
alone  ;  fear  of  thunderstorms  to  such  a  degree  that  when- 
ever the  day  becomes  dark  and  cloudy  there  is  inoense 
anxiety  lest  there  should  be  a  storm ;  intense  fear  of  meet- 
ing people;  haunting  ideas  which,  if  voluntary,  would 
have  been  blasphemous;  similar  haunting  ideas  associ- 
ated with  obscene  things ;  fear  of  harming  other  people  ; 
inability  to  sign  name  in  public. 

Among  other  examples  one  finds  a  man  of  nervous 
temperament  who  was  obsessed  with  the  feeling  that  he 
was  going  to  be  sick  ;  when  visiting  friends  this  idea  be- 
came so  strong  as  to  dominate  his  thought  and  pro- 
duced such  a  state  of  apprehension  that  he  often  had  to 
go  home.  In  spite  of  experience  that  the  sickness  never 
happened  the  obsession  remained.  Also  a  middle-aged 
woman  who  suffered  mental  torture  from  a  persistent 
fear  that  she  might  develop  meningitis,  or  sore  throat ; 
other  illnesses  did  not  interest  her,  but  of  these  two  she 
had  the  greatest  horror.  Again,  a  yomig  woman's  work 
was  hampered  by  her  mind  continually  dwelling  on  the 
false  idea  that  she  was  wanting  in  mental  power  and 
would  probably  one  day  "go  out  of  her  mind  ";  a  prey 
to  numerous  obsessions,  she  also  suffered  from  doubts 
about  words,  questions,  and  many  trifling  things  requir- 
ing decision  in  daily  life,  whilst  closed  spaces  were  ab- 
horrent to  her. 

The  following  is  an  example  of  the  great  annoyance 
obsessions  sometimes  occasion.  Out  of  a  host  of  tire- 
some fears  and  troublesome  thoughts  the  following  were 
given  as  typical  instances  :  "I  have  feared  to  omit,  after 
signing  my  name,  to  draw  a  line  from  the  signature  to  the 


MORBID  FEARS  AND  DOUBTS  121 

bottom  of  the  paper  and  up  again,  touching  the  paper 
three  times  with  the  pen  in  the  upstroke,  repeating  the 
whole  of  the  performance  three  times.    If  this  were  not 
done  I  feared  to  let  the  signature  go  out  of  my  hands  or 
be  posted.     By  slow  degrees,  and  cautious  attempts,  I 
reduced  this  to  apply  only  to  cases  where  the  signed 
article  was  posted  without  mentioning  the  posting  to 
someone.     I  have  feared  to  omit  to  turn  a  bolt-handle 
three  times  before  going  to  bed  after  first  looking  at  three 
windows,  and  stretching  upward.    This  has  been  broken 
to  the  extent  of  not  going  to  bed  till  about  one  o'clock 
next  morning,  when  I  did  it.     I  have  feared  to  omit 
taking  a  certain  walk  for  three   (or  four)   Sundays  in 
succession ,  and  it  is  difficult  to  omit  it  at  all  on  a  Sunday. 
This  is  a  great  hindrance  from  leaving  home,  and  is  a 
burden    when    I    am    not    weU    on    Sunday.      I    have 
feared  to  omit  to  wash  out  my  mouth  nine  times  with 
izal   after   smoking,   before   eating.      I   have   feared  to 
finish  smoking  a   cigarette  except  in  a   certain  room. 
These  are  some  of  the  worst  fears,  but  there  are  many 
smaller  fears  such  as  the  speaking  of  certain  words  under 
certain  conditions,  the  not  laying  down  of  pins  in  certain 
places,  the   spending   of   pennies  which  have  not   been 
changed  from  one  pocket  to  another  and  afterwards  to  a 
third,  which  idea  originated  in  a  fear  of  spending  know- 
ingly a  penny  with  a  king's  head  on  it  instead  of  a  queen's. 
In  aU  these  cases  the  thing  that  is  feared  is  the  production 
by  fear  of  some  disease  which  would  end  fataUy,  com- 
mencing either  immediately  or  at  a  prescribed  time  after 
the  breaking  of  the  inhibition.     I  have  been  through 
three  days,  a  fortnight,  and  even  twice  through  eighteen- 
month  periods  after  the  partial  breaking  of  inhibitions, 
but  have  escaped  iQ-consequences,  I  am  thankful  to  say. 
I  once  deliberately  broke  an  inhibition  of  walking  along 
a  path  in  which  I  feared  I  should  have  a  fit.    My  heart 
beat  furiously  for  some  time  afterwards,  but  got  quieter. 
This  was  some  twenty  years  ago.    A  doctor  informed  me 


122  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

that  the  palpitation  was  probably  due  to  the  fact  that  I 
had  gone  out  of  my  way  to  break  the  inhibition." 

As  if  these  things  were  not  enough  to  hamper  seriously 
the  business  of  life,  the  following  was  subsequently  added  : 
"  Then  there  is  that  difficulty  about  signing  a  letter  and 
posting.  I  am  afraid  of  signing  a  letter  without  making 
certain  marks  and  strokes  after  my  name,  even  with  an 
empty  pen.  By  dint  of  hard  work  and  friends'  assistance 
I  got  as  far  as  signing  my  name  with  hut  small  marks  so 
long  as  I  did  not  post  it,  except  when  I  told  my  wife 
beforehand."  He  could  send  it  by  hand  or  carry  it,  but 
this  meant  that  (without  having  made  the  large  marks — 
although  not  showing)  he  could  not  post  a  letter  without 
referring  to  his  wife.  When  she  was  not  at  home,  there- 
fore, "  my  difficulty  became  great."  "  This  began  when 
my  first  nervous  breakdown  occurred  (some  six  or  seven 
years  ago),  the  first  obsession  being  the  drawing  of  a  line 
from  the  signature  to  the  bottom  of  the  paper  and  up 
again — some  three  times  (see  above).  This  difficulty  is 
to-day  much  the  same."  Once  whilst  his  wife  was  abroad 
a  friend  asked  him  to  sign  a  paper  which  he  did,  without 
making  large  marks,  and  the  friend  then  went  and  posted 
it.  No  undue  fear  attacked  him,  although  he  was  a  little 
uneasy  on  this  account,  But  further  relief  was  afforded 
by  informing  his  wife,  who  was  in  Switzerland,  that  the 
letter  had  been  posted.  The  fear  was  of  disease — "  the 
worst  disease  " — contmgent  on  not  fulfilling  the  require- 
ments of  the  obsession.  "  Although  I  understand  it 
would  be  safe  to  omit  the  marks,  I  camiot  brmg  myself 
to  believe  it  sufficiently  to  act  on  it  in  practice." 

Thus  obsessing  thoughts  take  many  forms,  but  always 
have  their  tormenting  influence  based  on  an  element  of 
fear.  Without  this  they  are  merely  a  nuisance,  and  the 
quickest  way  to  attack  them,  therefore,  is  to  assail  the 
dread  that  lurks  behind  them.  A  simple  effort  of  will 
commonly  makes  them  worse  in  that  it  accentuates  a 
desire  to  get  away  from  them,  as  if  they  mattered.     On 


MORBID  FEARS  AND  DOUBTS  123 

the  other  hand,  to  strive  for  some  understanding  of  their 
nature,  and  to  realize  that  they  are  bogies  which  have  no 
power  which  their  victim  does  not  himself  ascribe  to 
them  is  to  extract  their  sting.  Of  varieties  of  obsessions 
not  above  mentioned  passing  reference  may  be  made  to 
the  haunting  phrases  and  sentences — often  in  the  form  of 
questions — which  sometimes  occur.  Just  as  sometimes 
a  tune  will  ring  in  one's  head  annoyingly,  but  with  a 
thousand  times  greater  insistence,  will  particular  phrases 
haunt  some  people  ;  such  are  :  Why  is  the  earth  round  ? 
Where  is  heaven  ?  What  are  the  evidences  of  survival  ? 
I  am  the  man  !  and  so  on  and  so  forth.  When  the  haunt- 
ing idea  is  of  a  repellent  character  the  torture  it  occasions 
is  necessarily  aU  the  greater. 


CHAPTER  IV 

NERVOUS  INDIGESTION 

Dyspepsia  a  common  accompaniment  of  nervous  disorder — Tone  and 
its  failure — Digestive  processes  susceptible  to  mental  influences — 
Definitions  of  nervous  indigestion — Consequences  of  dyspepsia — 
Vicious  circle — Characteristics  of  nervous  dyspepsia — Auto-intoxi- 
cation— Secondary  consequences — Classification  of  cases — Mucous 
colitis — Common  misconceptions — Treatment  must  be  mental  as 
weiras  physical. 

INDIGESTION  is  one  of  the  commonest  ailments  for 
which  people  consult  a  doctor,  and  remarkably  often 
the  dyspepsia  has  a  neurasthenic  basis.  Consequently, 
one  of  the  commonest  misconceptions  of  illness  is  that 
which  leads  people  to  be  treated  for  a  primary  disturbance 
of  the  digestive  organs  when  all  the  time  the  root  of  their 
indigestion  is  to  be  found  in  a  failing  nervous  system. 
Certainly  amongst  those  who  are  admittedly  suffering 
from  "  nerves  "  one  finds  that  indigestion  is  one  of  the 
discomforts  most  frequently  complained  of.  So  common, 
indeed,  that  many  writers  have  felt  compelled  to  describe 
"  gastric  neurasthenia  "  as  a  special  variety  of  the 
malady  ;  although  as  previously  noted,  it  is  neither 
necessary  nor  desirable  to  try  and  divide  so  protean  a 
disorder  into  too  definite  sub-groups.  Nevertheless,  the 
frequency  with  which  neurasthenia  is  associated  with 
digestive  troubles  makes  it  convenient  to  give  separate 
consideration  to  this  combination  which  has,  be  it  noted, 
achieved  rank  as  a  popularly  recognized  form  of  illness 
under  the  names  of  "  nervous  indigestion  "  or  "  nervous 
dyspepsia." 

Let  us  see  how  it  is  that  failure  of  nerve -strength  so 

124 


NERVOUS  INDIGESTION  125 

readily  leads  to  weakened  digestive  powers>  Apart 
from  the  general  want  of  muscular  power  associated 
with  neurasthenia,  the  question  of  tone  has  to  be  con- 
sidered. In  health  the  nervous  system  is  continually 
sending  out  impulses  which  serve  to  maintain  efficient 
elasticity  in  all  muscular  organs.  These  messages  not 
only  maintain  '*  tone,"  in  the  voluntary  muscles  of  the 
limbs  and  body,  but  keep  up  to  the  right  pitch  of 
elasticity  the  automatical  working  of  muscles  of 
stomach,  intestines,  and  other  internal  organs.  If  an 
accident  or  operation  severs  the  nerve -trunks  supplying 
the  muscles  of  the  arm,  for  example,  the  individual  muscle 
groups,  apart  from  loss  of  power,  become  slack  and 
wanting  in  tone.  It  is  the  same  with  aU  other  muscular 
parts.  Tone  is  important  in  that  it  holds  the  muscle - 
fibres  in  a  position  of  readiness  to  act.  Where  through 
iUness  or  other  cause  there  is  great  slackness  in  arm  or 
leg,  the  ability  to  move  quickly  is  handicapped  by  want 
of  tone.  On  the  contrary,  in  health  the  tonicity  main- 
tained enables  movements  to  be  carried  out  with  great 
swiftness.  In  short,  tone  is  an  alertnees  of  the  body  a.nd 
its  organs,  which  makes  for  efficiency  on  all  occasions.^ 

When  the  nature  of  bodily  tone  is  understood,  it  is  easy 
to  see  how  ability  to  respond  quickly  to  the  calls  of  daily 
life  must  fail  when  debility  reaches  those  wonderful 
central  batteries — ^the  brain  and  spinal  cord.  On  the 
physical  side  the  neurasthenic  state  represents  a  slack 
nervous  system,  hence  associated  with  it  one  fre- 
quently finds  poor  elasticity  in  stomach  and  bowel. 
Slack  nerve -cells  mean  slackness  not  only  of  the  whole 
physical  man,  but  of  his  digestive  organs  ;  feeble  diges- 
tive apparatus  means  a  variety  of  dyspeptic  troubles. 

-  Webster  defines  physiological  tone  as  "  that  state  of  the  body  or 
of  any  of  its  organs  or  parts,  in  which  the  animal  functions  are 
healthy  and  performed  with  due  vigour."  By  the  same  authority 
physiological  tonicity  is  defined  as  "  state  of  mind  ;  temper  ;  mood." 
Also  atony  as  "  want  of  tone  or  vital  energy,  weakness  of  the  system,  or 
of^any,  especially  contractile^organ." 


126  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

In  a  word,  nervous  indigestion  is  a  particular  local  mani- 
festation of  the  total  flabbiness  which  is  at  the  root  of 
the  neurasthenic  person's  troubles,  and  therefore  often 
depends  primarily  on  those  emotional  disturbances  which 
play  such  a  leading  part  in  producing  the  nervous  dis- 
turbance. 

This  view  is  supported  by  many  competent  observers, 
whilst  years  ago  Sir  Lauder  Brunton  called  attention  to 
the  way  in  which  worry  or  other  mental  disturbance 
profoundly  affects  digestion.  He  said:  "  The  effect  of 
emotion  upon  the  stomach  is  well  known.  A  piece  of 
bad  news  takes  away  the  appetite,  and  may  even  bring 
on  sickness.  Mental  work  immediately  after  a  meal  is 
very  apt  to  disturb  digestion,  and  if  carried  on  regularly 
may  lead  to  dyspepsia.  I  was  once  staying  at  a  hydro- 
pathic establishment  near  a  large  commercial  town, 
when  I  observed  that  one  of  the  rules  was  that  any 
patient  taking  up  a  newspaper  within  an  hour  after 
dinner  was  fined  one  shilling.  The  reason  for  this  was 
that  the  patients  who  came  there  were  chiefly  engaged 
in  business,  and  the  first  thing  they  turned  to  in  a  news- 
paper was  the  money  column  ;  thus  their  minds  became 
occupied  with  commercial  affairs  after  meals,  and  diges- 
tion was  not  so  good.  Excessive  weariness  tends  to  cause 
indigestion,  because  the  worried  stomach  and  nervous 
systems  do  not  respond  to  the  stimulus  of  food.  Worry, 
anxiety,  disappomtments,  and  especially  a  love  affair, 
all  tend  to  cause  dyspepsia."  The  same  author  wrote  : 
"It  is  important,  as  far  as  possible,  to  avoid  fatigue 
before  meals,  and  to  get  rid  of  all  worry  and  thoughts 
about  business  during  meals.  Some  people  damage  their 
digestion  by  walking  from  their  work  with  the  notion  of 
getting  an  appetite.  The  extra  labour  caused  by  this 
finishes  up  the  patient,  already  exhausted  by  his  daily 
work,  andjessens  the  digestive  powers  still  more.  Twenty 
minutes'  restfat|least  after  getting  home  is  a  useful  re- 
storative, and  is  advisable  for  dyspeptics,  especially  for 


NERVOUS  INDIGESTION  127 

patients  at  or  above  middle  age.  On  the  other  hand,  if 
the  occupation  be  of  a  harassing  or  anxious  kind,  it  is 
sometimes  useful  for  the  patient  to  walk  home  instead  of 
driving,  in  the  hope  of  getting  rid  of  his  anxiety  and 
worry  by  exercise.  If  rest  can  be  taken  on  arrival  the 
disadvantage  caused  by  the  extra  bodily  work  in  such 
cases  may  be  more  than  compensated  by  the  relief  to  the 
mind.  After  the  meal  is  over,  rest  is  required  both  for 
body  and  mind,  and  active  exertion,  either  bodily  or 
mental,  is  injurious  ;  it  is  advisable  to  rest  half  an  hour 
or  more  if  possible.  During  this  time  pleasant  conversa- 
tion or  light  reading  or  a  pipe  may  direct  the  thoughts 
from  care."  Dubois  goes  so  far  as  to  declare  that  "  ninety 
per  cent  of  dyspeptics  are  psychoneurotics,  and  that  all 
these  patients  should  have  nothing  to  do  with  restricted 
diet  and  stomachic  medication."  ^  He  emphasizes  his 
belief  that  our  method  of  approaching  all  manifestations 
of  nervous  indigestion  should  be  constant,  and  "the  same 
in  the  various  dyspepsias  with  eructations,  vomitings, 
sharp  pain  and  heaviness  in  the  stomach,  dilatation  and 
gastroptosis.  It  is  bad  to  begin  the  treatment  by  admit- 
ting, in  such  cases,  a  primary  affection  of  the  stomach,  or 
'  stomachic  nervousness.'  It  is,  on  the  contrary,  the 
stomach  which  suffers  from  the  counter  effect  of  the 
nervous  condition."  ^ 

The  late  Dr.  George  HerscheU,  who  devoted  special 
attention  to  the  study  of  this  condition,  defined  it  as  "  an 
affection  of  the  stomach  of  nerve  origin,  accompanied  by 
an  indigestion  resembling  very  much  the  flatulent  dys- 
pepsia of  chronic  gastritis.  It  is  evidently  due  to  abnor- 
mality of  function  in  the  nerves  which  preside  over  the 
stomach  and  intestines,  more  than  two-thirds  of  all  the 
cases  of  this  complaint  met  with  in  practice  being  part  of 
a  general  neurasthenia."  ^ 

^  Paul  Dubois,  M.D.,  The  Psychic  Treatment  of  Nervous  Disorders, 
p.  258.  2  jfji^^ 

*  George  HerscheU,  M.D.,  Indigestion,  p.  159. 


128  THE  PROBLEM  OF  NERVOUS  BREAKDOV/N 

However,  one  must  not  forget  that  some  specialist 
investigators,  the  late  Dr.  T.  D.  Savill  prominently  among 
them,  have  considered  that  in  very  many  instances  the 
nervous  illness  is  a  result  rather  than  a  cause  of  the  stomach 
disorder.  But  this  view  does  not  account  for  the  early 
failure  of  digestive  power  as  expressed  by  the  slackening 
stomach  wall ;  nor  does  it  square  with  the  common 
observation  that  so  often  the  development  of  the  indiges- 
tion has  been  preceded  many  years  previously  by  signs  of 
constitutionally  low-level  of  nervous  vitality  which  has 
necessarily  included  the  digestive  organs  in  its  general 
effects.  Dr.  Savill  held  "  that  gastric  disorder  produces 
neurasthenia  by  an  autotoxic  condition  of  the  blood 
acting  on  the  nervous  system.  There  can  be  no  doubt 
that  gastric  disorder  results  in  a  defective  elaboration 
of  the  products  of  digestion,  and  the  pouring  into  the 
blood  of  a  large  quantity  of  imperfectly  elaborated  and 
toxic  products.  Constipation  is  capable  of  acting  detri- 
mentally in  the  same  way  owing  to  the  reabsorption  of 
many  materials  which  are  intended  for  excretion."  ^  He 
further  wrote :  "  Bad  food  or  a  dietary  containing  a 
deficiency  or  excess  of  certain  articles,  even  without 
indigestion,  are  some  of  the  other  errors  which,  in  persons 
otherwise  predisposed  may,  I  believe,  give  rise  to  neuras- 
thenia." ^  At  the  same  time,  he  qualified  these  state- 
ments as  follows  :  "  It  may  be  that,  in  some  cases,  a 
contributory  cause  is  necessary  to  render  the  nervous 
system  inherently  weak  ;  but  such  a  cause  does  not 
seem  to  be  always  necessary  ;  certainly  in  many  cases 
it  cannot  be  revealed,  and  one  is  almost  led  to  infer  that 
the  toxic  products  of  digestion  have  a  specifically 
poisonous  effect  on  nerve  structures."  ^ 

What  is  true  enough  is  that  once  the  nervous  indiges- 
tion has  well  developed  it  of  itself  reacts  severely  on  the 
nervous  system,  and  it  is  then  that  the  fermentation 

1  T.  D.  Sa\'ill,  M.D.,  Lectures  on  Neurasthenia,  p.  83. 

2  Ibid.  -     »  Ibid. 


NERVOUS  INDIGESTION  129 

products  of  deficient  action  in  fetomach  and  bowel  further 
poison  and  weaken  the  already  debilitated  nerve -cells. 
Thus  is  set  up  a  species  of  "  vicious  circle  "  which  is  very 
commonly  observed.  Here  the  sequence  of  events  is  that 
a  delicate  nervous  system  through  overstrain  leads  to 
weakened  digestion ;  impaired  work  of  stomach  and 
intestines  permits  fermentation,  and  fermentation  in- 
variably results  in  the  production  of  substances  highly 
poisonous  to  the  "nerves,"  whUst  the  poor  state  of  the 
digestive  organs  allows  them  to  be  all  the  more  quickly 
absorbed  into  the  system,  and  so  to  attack  the  central 
nervous  system  directly.  These  poisons,  strongly  re- 
acting on  the  debilitated  nerve-centres,  lead  to  further 
weakening  of  stomach  and  bowel,  so  that  the  debilitating 
process  goes  round  in  that  morbid  circle  which  so  com- 
monly leads  to  chronic  invalidism  and  great  emaciation. 
To  cure  the  sufferer  the  circle  must  be  cut  somewhere, 
and  the  task  is  a  hard  one,  although  in  the  early  stages 
there  are  no  insurmountable  difficulties. 

The  late  Sir  James  Goodhart  used  to  draw  attention  to 
the  nervous  element  in  so  many  misunderstood  cases  of 
stomach  and  bowel  disorder,  and  also  to  the  way  in  which 
worry,  for  example,  will  occasion  furring  of  the  tongue, 
tilting  against  the  time-honoured  convention  that  such 
furring  necessarily  sign?Js  important  digestive  trouble. 
In  his  usual  spirited  manner,  he  derided  this  popular 
medical  "  obsession,"  suggesting  that  "  there  is  no  more 
ineradicable  idea  in  the  mind  of  the  doctor  than  that  the 
furred  tongue  is  essentially  an  indication  of  a  deranged 
stomach,  and  it  is  probably  an  attempt  to  kick  against 
the  pricks  to  say  otherwise.  That  a  dirty  tongue  is  an 
indication  that  the  liver  is  out  of  order,  and  that  a  purge 
of  some  sort  is  the  one  and  only  remedy  will,  I  suppose, 
never  cease  to  be  thought- as  long  as  the  world  lasts,  and 
in  a  fair  proportion  of  cases  I  am  not  prepared  to  traverse 
the  practice.  But  it  is  by  no  means  always  so  ;  a  dirty 
tongue  does  not  always  mean  a  foul  stomach.  .  .  .  Nerv- 


130  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

ous  fears  and  nervous  tastes  are  common  enough,  and 
they  demand  a  special  thought."  ^  Sir  James  aptly- 
reminded  us  that  "  Quinney  squirmed  at  the  remote 
possibility  of  being  merged  and  lost.  He  muttered  un- 
easily, '  It  fair  furs  my  tongue  to  think  o'  that.'  " 

The  question  of  disturbed  taste  is,  indeed,  interesting. 
One  finds  over-sensitiveness  to  certain  flavours,  loss  of 
taste  to  others,  or  complete  loss  of  taste  and  smell  as 
results  of  a  disordered  nervous  system.  Sometimes  one 
has  to  deal  with  persistent  tastes  that  are  found  trouble- 
some. There  comes  to  mind  a  man  who  always  had  a 
sweet  taste  in  his  mouth  ;  nothing  to  bother  about,  it 
might  be  said,  but  he  became  so  anxious  lest  this  should 
portend  something  about  to  happen  to  his  brain  that  his 
sleep  and  capacity  for  work  were  seriously  influenced  for 
a  time.  Here,  as  so  often,  it  was  the  fear  of  the  unknown 
that  was  the  main  trouble,  and  probably  the  sweet  taste 
itself  was  "  fixed  "  by  just  some  such  fear  set  up  in  the 
thought  of  an  over-active  and  rather  tired  individual. 

The  chief  characteristics  of  nervous  indigestion  are  its 
persistency  and  the  variety  of  symptoms  it  occasions. 
Flatulence  and  distress  after  food  are  common,  as  also  is 
sense  of  great  hunger  satisfied  by  very  little  food,  but 
recurring  again  within  a  couple  of  hours.  The  actual  dis- 
comfort experienced  may  be  anything  from  slight  sense 
of  weight  or  fulness,  to  disturbing  pain ;  sensations  of 
gnawing  or  burning  felt  at  the  pit  of  the  stomach  are 
quite  common.  Sour  eructations  into  the  throat  often 
occur,  and  may  be  associated  with  a  sore,  red  tongue. 
In  long-standing  cases,  where  there  is  dilatation  of  the 
stomach,  a  considerable  quantity  of  fluid  may  be 
brought  up  from  time  to  time.  Even  where  there 
is  no  distension,  the  bringing  up  of  a  small  quantity  of 
mucus  and  undigested  food  is  a  troublesome  feature  that 
bothers  many  neurasthenic  people,  and  in  itseK  signifies  the 

1  Sir  James  Goodhart,  M.D.,  "  On  Nervous  Furring  of  the  Tongue 
and  Disturbed  Taste,"  The  Lancet,  September  25th,  1915. 


NERVOUS  INDIGESTION  131 

unhealthy  state  into  which  the  lining  mucous  membrane 
of  the  stomach  has  fallen.  Indigestion  is  not  necessarily 
centred  in  the  stomach,  but  may  be  manifested  mainly 
in  the  intestines  when  some  or  all  of  the  following 
symptoms  may  indicate  that  the  bowel  is  not  functioning 
properly  :  flatulence,  rumblings,  spasmodic  pain,  irregu- 
lar action  of  the  bowels,  intermittent  mucous  discharges, 
and  abnormal  character  of  the  motions.  It  helps  us  to 
understand  the  difficult  problems  of  nervous  dyspepsia 
if  we  realize  that  the  abdominal  organs  share  in  the 
general  morbid  hypersensitiveness,  and  that  in  con- 
sequence minor  discomforts  or  pain  which  in  an  individual 
of  strong  nervous  fibre  would  scarcely  be  noticed  may 
be  felt  as  acute  distress  when  troubling  a  neurasthenic 
person. 

A  particularly  unpleasant  feature  of  neurasthenic 
indigestion  is  the  disturbed  nights  it  often  leads  to.  The 
sufferer  wakes  up  in  the  early  morning  hours  feeling  low- 
spirited,  chilly,  and  very  hungry.  There  may  be  trouble- 
some intestinal  squirms  and  rumblings.  Then,  unless 
food  of  some  kind  is  taken,  the  discomfort  persists,  or 
may  increase,  so  that  no  more  rest  is  obtained,  and  the 
morning  dawns  on  a  thoroughly  unhappy  and  disgruntled 
individual,  who  feels  quite  unfit  to  take  up  his  daily  task. 
Many  dyspeptics  keep  a  few  biscuits  by  their  bedside 
with  which  to  combat  the  early  morning  attack.  Others 
make  a  habit  of  rising  and  brewing  a  cup  of  tea  or  making 
some  cocoa.  Best  of  all  is  the  use  of  a  heat-retaining  flask 
in  which  a  warm  drink  can  be  kept  ready  to  hand.  Often 
enough  a  glass  of  water  serves  to  restore  ease  and  sleep. 

Considering  the  subject  in  more  detail,  it  is  to  be  noted 
that  sufferers  from  nervous  indigestion — ^the  dyspeptic 
neurasthenics — usually  come  with  a  history  of  many 
years'  chronic  Hi-health,  which  has  been  combated  with 
varying  success  and  assistance  from  numerous  qualified 
and  unqualified  practitioners  of  healing  arts.  Birds  of 
passage  from  one  consulting  room  to  another,  and  from 


132  THE  PROBLEM  OP  NERVOUS  BREAKDOWN 

one  treatment  to  another,  they  have  largely  lost  con- 
fidence in  anything  that  may  be  suggested  for  their 
health,  yet  must  needs  seek  a  little  more  advice  for  a 
condition  of  things  which  hampers  their  work,  upsets 
their  domestic  happiness,  and  bids  fair  to  rob  them  of 
that  considerable  success  in  life  which  the  neurasthenic 
quite  often  finds  within  his  reach. 

Commonly  below  weight,  and  of  delicate  appearance, 
the  sufferer  plunges  straightway  into  a  story  of  persistent 
discomfort  after  meals,  with  flatulence,  abdominal  dis- 
tension and  pain  ;  however  careful  he  is  in  regard  to 
meals,  he  suffers  from  sharp  "  attacks  of  indigestion," 
usually  accompanied  by  a  feeling  of  biliousness,  furred 
tongue,  lassitude,  headache  and  want  of  spirits.  Fre- 
quently enough  there  is  constipation  ;  but  it  is  also 
quite  common  for  the  patient  to  be  unaware  that  the 
bowels  are  really  sluggish  in  action.  Again,  not  infre- 
quently one  is  told  that  indigestion  and  flatulence  are 
sometimes  accompanied  with  or  varied  by  colicky  pains, 
with  numerous  loose  slimy  motions.  When  this  is  the 
case,  it  is  usual  to  be  told  that  such  abdominal  attacks 
are  separated  by  periods  of  obstinate  constipation. 

Further  questioning  commonly  reveals  clues  to  the 
nervous  element  in  the  case.  Thus  it  is  perhaps  revealed 
that  the  invalid  sleeps  badly,  gets  "  brain  fag  "  after 
comparatively  little  work,  finds  himself  breathing  heavily 
after  a  little  sharp  physical  exercise,  or  bothered  by 
general  nervousness  and  sense  of  mental  discomfort  in 
various  ways.  Examination  shows  that  no  gross  organic 
disease  is  present,  but  there  are  evidences  of  slackness 
and  irregularity  of  action  in  the  muscular  coats  of  stomach 
and  bowel.  Splashing  and  distension  show  that  instead 
of  being  normally  elastic  and  properly  contracted  the 
alimentary  passages  are  flabby  and  contain  much  gas. 
This  picture  is  as  familiar  in  the  consulting-room  of  the 
general  physician  and  family  doctor  as  in  that  of  the 
specialist.    There  are  two  main  factors  at  work  in  pro- 


NERVOUS  INDIGESTION  133 

ducing  it,  namely,  the  constitutional  neurasthenia,  and  a 
state  of  poisoning  commonly  secondary  thereto  and  asso- 
ciated with  the  debilitated  condition  of  stomach  and 
bowel. 

Of  this  poisoning  a  number  of  familiar  signs  gives 
evidence,  particularly  headache,  disturbed  sleep  with 
morning  tiredness,  foul  brea,th,  tired  eyes,  indefinite  pains 
in  back  and  limbs,  dull  cadaverous -like  skin,  and  presence 
of  indican  and  aUied  products  of  faecal  decomposition  in 
the  urine  ;  whilst  obstinate  constipation  and  furred 
tongue  may  indicate  an  obvious  physical  basis  for  it. 
But  as  in  the  majority  of  cases  we  can  trace  a  history  of 
fatigue  on  slight  exertion  back  to  early  years,  and  very 
often  on  account  of  some  adolescent  psycho-neurosis, 
youthful  nervousness  or  childhood's  nerve-storm,  there 
is  some  difficulty  in  estimating  to  what  extent  the  ex- 
haustion and  functional  nervous  disturbance  is  due  to 
primary  asthenia,  and  to  what  extent  it  is  a  secondary 
result  of  gastro-intestinal  poisoning.  Nowadays  there 
is  an  inclination  to  attribute  all  the  neurasthenic  symp- 
toms characteristic  of  such  cases  to  the  poisoning,  re- 
gardless of  the  fact  that  so  many  patients  suffering  in 
this  way  bear  in  themselves  the  obvious  signs  of  a  delicate 
constitution,  including,  of  course,  a  weak  nervous  system. 
For  in  my  experience  instances  are  comparatively  rare  in 
which  a  strong,  healthy  man  or  woman,  free  from  nervous 
taint,  becomes  so  injured  in  health  as  to  develop  a  chronic 
auto-intoxication,  which  reacts  on  the  nervous  system 
so  as  to  bring  about  a  prolonged  neurasthenic  state.  On 
the  other  hand,  cases  are  extremely  common  in  which 
a  rather  delicate  person  who  has  always  been  inclined  to 
undue  fatigue  after  exertion,  and  whose  energies  have 
never  given  enough  margin  for  the  ordinary  demands  of 
daily  work  and  pleasure,  gradually  finds  digestion  and 
bowel  action  diminishing  in  efficiency  ;  there  being  at 
the  same  time  indications  that  the  natural  want  of  vigour 
is   being   further  increased   by   auto-intoxication.     The 


134  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

difficult|cases  are  those  in  which  physical  signs  are  not 
much  in  evidence,  and  where  there  is  all  the  difference 
between  suspicion  and  confirmation.  Fortunately,  by 
careful  X-ray  examination  after  a  bismuth  meal,  or  by 
other  tests,  it  is  possible  to  detect  sluggish  peristalsis 
action  without  difficulty,  and  it  may  be  taken  as  a  cer- 
tain axiom  that  when  there  is  such  alimentary  langour, 
poisoning  is  a  possibility  that  requires  serious  con- 
sideration. 

But  the  very  facility  with  which  modern  technique  has 
provided  us  in  the  matter  of  detecting  bowel  stasis,  and 
suggesting  physical  grounds  for  a  diagnosis  of  chronic 
auto-intoxication,  is  in  itself  a  trap  to  the  unwary  medical 
man  who,  carried  away  by  local  conditions,  may  be  in- 
clined to  forget  the  primary  neurasthenic  state  at  the 
root  of  the  illness.  This  essential  want  of  vitality  per- 
sists, however  efficiently  the  muscles  of  the  stomach  and 
intestines  may  be  '  toned  '  up  by  massage,  electricity, 
or  what  not,  and  however  thoroughly  the  sluggish  bowel 
be  drained.  It  is  owing  to  this  common  misunderstand- 
ing of  the  factors  producing  the  vicious  circle  which  drags 
down  the  health  of  the  dyspeptic  neurasthenic  that  in 
one  consulting-room  the  invalid  is  said  to  be  suffering 
from  gastric  trouble — catarrh,  dilatation,  gastroptosis, 
and  so  on  ;  in  another,  his  case  is  diagnosed  '  neuras- 
thenia '  ;  and  in  yet  another  he  is  said  to  be  suffering 
from  intestinal  auto -intoxication  ;  whilst  in  a  fourth  he 
may  be  told  that  '  colitis  '  is  the  main  source  of  all  his 
troubles.  These  things  may  be  true  enough,  but  they 
represent  parts  and  not  the  whole  malady.  It  is  because 
an  illness  of  this  kind  is  often  not  understood  in  its 
entirety,  and  is  believed  to  depend  wholly  on  some  local 
disturbance,  that  so  many  dyspeptic  neurasthenics 
receive  but  temporary  benefit  from  treatment.  This  is 
unfortunate,  because  when  one  takes  the  broad  view  a 
great  deal  can  be  done  to  increase  the  total  efficiency 
and  usefulness  of  such  semi-invalids,  to  say  nothing  of 


NERVOUS  INDIGESTION  135 

vastly  adding  to  their  family  happiness  and  comfort  in 
life. 

When  the  indigestion  resists  all  remedies  and  becomes 
a  constant  source  of  impairment  there  gradually  arises 
a  train  of  secondary  consequences,  other  than  those 
already  specified,  which  tends  to  confirm  the  invalidism 
and  to  make  efiective  treatment  more  and  more  difficult. 
In  two  directions  especially  does  this  tendency  manifest 
itself.  On  the  one  hand,  the  persistent  pain,  or  other 
local  distress,  often  leads  the  sufferer  to  conclude  that  he 
is  reaUy  the  victim  of  some  grave  disease  that  has  been 
overlooked.  To  the  misery  of  previous  discomfort  be- 
comes added  a  hopeless  feeling  of  being  outside  the  reach 
of  the  doctor's  skill.  People  are  reluctant  to  beHeve 
that  so  pressing  a  malady  can  possibly  be  dependent  on 
some  mind  disturbance,  or  disorder  of  their  "  nerves," 
and  seize  on  the  slightest  excuse  for  assuming  that 
they  have  a  deep-seated  organic  disease.  The  worst  of 
it  is  that  the  more  a  conscientious  doctor  endeavours  to 
make  certain  of  his  diagnosis  by  resorting  to  X-ray 
examinations,  estimation  of  stomach  contents,  or  opinions 
of  physicians  specializing  in  abdominal  troubles,  the 
more  do  they  secretly  decide  that  he  is  searching  for  that 
dire  disease  that  they  feel  sure  must  be  present.  Thus 
the  first  important  step  in  helping  those  sufferers  must  be 
to  give  them  a  clear  understanding  of  the  nature  of  their 
trouble  ;  and  to  convince  them  that  no  growth,  obstruc- 
tion or  other  gross  change  is  at  the  root  of  it.  Emphasis 
must  be  laid  on  the  fact  that  sensations  are  most  mis- 
leading both  as  to  the  nature  of  the  actual  disturbance 
and  as  to  where  it  is  reaUy  taking  place.  Thus  pain  very 
frequently  occurs  a  long  way  from  the  seat  of  trouble, 
maybe  on  the  opposite  side  of  the  body.  That  is  because 
the  automatic,  "  sympathetic,"  nervous  system  that  links 
up  the  abdominal  organs  is  characterized  in  one  respect 
by  an  inability  to  render  an  accurate  account  of  direction 
and  place.    As  a  consequence,  a  disturbance  on  the  right 


136  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

side  may  be  expressed  by  pain  on  the  left  ;  or  spasmodic 
contractions  of  the  bowel  may  be  reflected  in  discomfort 
apparently  referable  to  the  stomach.  It  may  be  said  at 
once  that  it  is  an  important  point  in  treatment  to  explain 
these  possible  fallacies  about  pain  and  local  sensations, 
as  it  encourages  invalids  to  become  less  fearful  of  their 
symptoms  when  they  realize  how  untrustworthy  first 
appearances  may  be. 

The  other  morbid  tendency  is  towards  attempted  self- 
cure  by  gradually  cutting  out  of  their  diet  special  things 
that  are  considered  to  increase  the  local  distress.  Oblivi- 
ous of  the  fact  that  the  true  remedy  for  a  tired  stomach 
is  to  train  it  to  digest  more  and  more  they  faU  into  the 
error  of  encouraging  the  refractory  organs.  Admitted 
that  one  comes  across  peculiar  and  undoubted  personal 
difficulties  in  different  people,  cheese,  cucumber,  and 
shell-fish  being  familiar  examples,  that  does  not  alter  the 
fact  that  the  neurasthenic  digestive  tract  has  to  be  treated 
first  like  the  neurasthenic  patient  himself.  It  must  be 
rested  at  the  outset,  but  subsequently  re-educated  and 
coaxed  into  fresh  life  and  activity.  There  is  a  story  of  a 
fine  old  octogenarian  who  at  a  late  supper  party  astonished 
a  neighbour  by  eating  lobster  salad.  On  bemg  asked 
with  surprise  how  he  could  eat  lobster  for  supper  at  his 
time  of  life,  and  if  his  stomach  would  not  rebel,  retorted, 
"  Sn,  my  stomach  has  to  eat  what  it  is  told  to  at  all 
times."  The  object  of  the  dyspeptic  neurasthenic  must 
be  to  treat  his  fatigued  organs  fairly,  but  never  to  forget 
that  it  is  intended  that  ultimately  they  shaU  dispose  of 
whatever  meals  he  may  decide  on.  And  in  dealing  with 
his  stomach  fairly  the  invalid  may  well  bear  in  mind  the 
reference  to  rest  just  made.  At  the  outset  of  a  "  cure  " 
for  severe  nervous  indigestion,  especially  where  there  is 
an  acute  attack  or  sudden  increase  of  symptoms,  there 
is  nothing  better  than  a  few  days'  rest  of  the  whole  system. 
Three  days  in  bed  on  the  lightest  diet  compatible  with 
proper  nourishment  will  often  work  wonders  and  form  a 


NERVOUS  INDIGESTION  137 

good  starting-point  from  which  a  systematic  routine  of 
treatment  may  be  carried  out. 

In  dealing  with  cases  of  this  kind,  the  great  outstanding 
fact  should  at  once  be  realized  that  the  problem  is  one  of 
income  and  expenditm-e.  That  is  to  say,  the  patient  has 
to  adjust  his  life  to  suit  his  avera.ge  coefficient  of  energy, 
otherwise  the  nervous  depletion  wiU  obstruct  any  attempt 
at  successful  treatment.  Clearly  this  raises  a  difficulty, 
for  it  is  not  open  to  every  one  to  change  life's  routine  at 
the  bidding  of  the  physician,  although  fortunately  one's 
task  is  rendered  less  arduous  the  more  the  principle  of 
conservation  of  nerve  energy  is  understood.  Hard  as  it  is 
to  augment  the  natural  vitality  of  the  neurasthenic,  it  is 
nevertheless  possible  to  enable  him  to  make  greater  use 
of  the  vigom'  that  is  in  him  by  practismg  the  most  strin- 
gent economy  in  regard  to  his  nervous  expenditure.  Regu- 
lar hours  for  work  and  rest,  scrupulous  routine  in  the 
matter  of  meals  and  sleep,  are  useful  energy-saving 
measures.  Where  the  system  flags,  brain,  stomach  and 
muscles  should  not  have  to  contend  at  any  particular 
moment  for  the  comparatively  small  amount  of  energy 
available  for  distribution  among  them  ;  but  when  one 
has  to  take  up  the  tale  of  daily  duty,  the  others  should 
rest  for  that  v/hile. 


CHAPTER  V 

HYSTERIA 

A  psychological  riddle — Hysteria  known  to  the  ancients — Pithiatism— 
Sydenham's  definition — Bygone  theories — Common  signs  of 
hysteria — Basis  of  the  hysterical  state — Disorders  of  movement — 
Curious  reactions — Disorders  of  sensation — Witch's  marks — Dis- 
turbances of  general  health — Hysterical  attacks — La  grande 
hysterie — Illustrations. 

WE  have  seen  that  neurasthenia  is  one  great  enigma 
of  medical  science,  but,  truth  to  tell,  this  remark- 
able group  of  maladies  is  eclipsed  in  point  of  singularity 
by  hysteria.  The  peculiar  state  of  mind  that  was  a  puzzle 
for  the  ancients,  and  a  question  of  demonology  in  the 
middle  ages,  remains  the  great  riddle  of  medico-psych- 
ology in  the  twentieth  century.  Certainly  Hippocrates 
was  familiar  with  this  baffling  disorder  of  mind  and  body, 
the  name  we  now  use  being  given  to  it  in  his  day,  whilst 
Pliny  wrote  about  hysteria  as  a  special  disease  of  women. 
Thus  it  is,  indeed,  an  interesting  example  of  a  common 
malady  recognized  at  the  dawn  of  medicine  and  described 
in  the  medical  schools  of  to-day  in  the  same  terms,  and 
under  the  same  name  that  was  applied  to  it  in  the  halls  of 
the  great  Greek  philosophers.  Now,  as  a  matter  of  fact, 
after  occupying  a  recognized  place  in  medical  nomencla- 
ture for  so  many  centuries,  the  term  hysteria  seems  likely 
to  be  ousted  by  a  new  title — ^pithiatism — coined  in  the 
modem  schools  of  French  neurology.  Be  it  noted,  that 
in  spite  of  its  time-honoured  use  as  a  scientific  expression 
it  has,  curiously  enough,  been  popularly  used  in  a  mean 
sense,  confusing  the  issue  and  failing  to  distinguish  one 
of  the  gravest  nervous  diseases  from  malingering.     No 

138 


HYSTERIA  139 

true  conception  of  the  problem  of  nervous  breakdown 
can  be  obtained  unless  it  be  clearly  recognized  that  in 
hysteria  we  have  a  very  real  disease  which,  although 
frequently  enough  indefinite  in  outline,  is,  nevertheless, 
accompanied  by  definite  mental  and  physical  characteris- 
tics. To  make  this  quite  clear  it  wiU  be  helpful  to 
review  the  manifestations  which  occur  in  this  particular 
nervous  disorder. 

Sydenham,  the  great  physician  of  Cromwellian  times, 
described  hysteria  in  terms  that  have  become  classical. 
He  said  :  "  Hysteria  imitates  almost  every  disease  which 
befalls  mankmd.  Whatever  part  of  the  body  it  attacks, 
it  wiU  create  the  proper  symptom  of  that  part.  Hence, 
without  skill  and  sagacity  the  physician  will  be  deceived, 
so  as  to  refer  the  symptoms  to  some  essential  disease  of 
the  part  in  question  and  not  to  the  effects  of  hysteria." 
And  in  regard  to  the  mental  states  of  hysterics  the  same 
able  observer  wrote  :  "All  is  caprice.  They  love  without 
measure  those  whom  they  will  soon  hate  without  reason. 
Now  they  will  do  this,  now  that,  ever  receding  from  their 
purpose."  Such  a  picture  drawn  by  a  master  hand  makes 
it  easier  for  us  to  understand  how  hysteria  has  not 
only  puzzled  doctors,  but  been  seriously  dealt  with  by 
priests,  philosophers,  and  law-givers  at  various  times  in 
the  world's  history.  Physicians  have  always  been  con- 
cerned with  hysterical  disturbances,  rightly  enough 
considering  them  in  the  nature  of  an  illness.  Philosophers 
have  been  fascinated  by  the  problems  presented  because 
of  the  possibility  that  the  extraordinary  mental  reactions 
and  apparent  phases  of  spiritual  exaltation  and  insight 
might  afford  a  key  to  their  own  researches.  Priests  have 
been  continually  worried  by  hysteria,  not  knowing 
whether  to  welcome  its  manifestations  on  occasion  as 
opening  up  communications  with  heaven,  or,  alterna- 
tively, as  demonstrating  the  agency  of  the  evU  one. 
Judges  have  been  called  in  by  perplexed  priests  and 
frightened  people  to  settle  these  matters  in  so  far  as  they 


140  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

have  been  thought  to  imperil  the  lives  and  welfare  of 
respectable  men  and  women.  Sadly  enough  for  sufferers 
from  hysteria,  priests,  philosophers,  doctors,  and  lawyers 
actually  found  themselves  in  agreement  about  these 
matters  some  three  hundred  years  ago  ;  they  were  of  one 
opinion  that  the  peculiar  stigmata  of  hysterical  persons 
represented  possession  by  Satan  or  his  minions.  Witch 
hunting  became  rife  and  for  a  few  years  almost  elevated 
into  the  position  of  a  national  sport,  as  those  who  have 
read  the  mournful  story  of  the  witches  know  full  well. 
Even  to-day  in  a  few  remote  hamlets  it  seems  likely  that 
hysteria  has  not  yet  been  finally  divorced  from  witch- 
craft in  the  folk-mind. 

The  main  physical  disturbances  commonly  resulting 
from  hysteria  may  be  indicated  in  a  few  words,  although 
their  combinations,  degrees,  and  detailed  character  vary 
so  much  that  one  could  speak  indefinitely  about  them. 
Of  the  mental  state  of  hysteria  volumes  have  indeed  been 
written,  and  with  the  best  intentions  in  the  world  it  is 
difficult  to  compress  all  one  would  like  to  say  about 
it  within  the  compass  of  a  few  pages.  Briefly  the 
more  usual  outward  signs  which  occur  in  hysteria  are 
paralysis,  varying  from  inability  to  move  the  fingers  or 
a  hand  to  complete  loss  of  movement  in  all  limbs  ;  abnor- 
malities of  sensation,  commonly  inability  to  feel  pain  or 
pressure,  heat,  or  cold  over  particular  areas  of  the  body, 
with  or  without  neuralgic  pains  ;  irregularities  of  the 
special  senses  and  involuntary  movements  of  all  kinds. 
It  is  sufficiently  obvious  that  were  these  the  only  troubles 
brought  about  by  hysteria  it  would  still  deserve  to  rank 
high  as  an  important  disease.  But  whilst  these  disorders 
may  be  such  as  entirely  to  incapacitate  the  individual 
affected,  in  addition  one  has  frequently  to  deal  with 
acute  states  of  mental  excitements,  violent  convulsive 
attacks,  severe  fevers,  serious  changes  in  the  skin, 
swellings,  and  hsemorrhages.  Moreover,  all  sorts  of 
combinations    of    symptoms    imitating    other    diseases 


HYSTERIA  141 

have  to  be  included  in  our  survey  and  kept  in  mind  as 
not  infrequent  accompaniments  of  this  form  of  nerv- 
ous breakdown.  It  would  be  difficult,  therefore,  to 
overestimate  the  importance  of  the  matter  we  have 
now  under  consideration. 

Subsequent  analysis  of  the  factors  leading  up  to  hji^teria 
will  show  us  that  nervous  instability  in  the  family 
tree,  and,  in  the  individual,  over-emotionalism  and 
abnormal  suggestibility  are  three  important  influences  ; 
that  wherever  there  are  conditions  favouring  their  action 
and  interaction  hysteria  soon  appears.  Thus  in  com- 
munities, large  or  small,  when  feeling  tone  is  raised  to  an 
abnormal  level  hysterical  outbreaks  become  prominent. 
Religious  revivals,  political  disturbances,  crazes  of  all 
kinds,  and  acute  international  situations,  obviously 
provide  a  setting  favourable  for  the  reaction  of  emotion- 
alism and  suggestion  on  large  masses  of  people  ;  all  the 
more  so  during  the  com'se  of  so  stupendous  a  conflict  as 
that  which  has  lately  shaken  civilization.  Further,  as 
the  strain  of  war  falls  for  the  most  part  on  armies  in  the 
field  so  it  is  not  surprising  that  in  the  nervous  disorders 
of  active  service  hysteria  occupies  an  important  place. 
When  we  come  to  discuss  the  psycho-neuroses  of  war 
more  detailed  consideration  will  be  given  to  this  aspect 
of  the  question. 

Amongst  the  most  readily  observable  of  hysterical 
states,  weakness  of  limbs  figures  prominently.  In  its 
most  advanced  development  there  is  paralysis  of  one 
side  of  the  body  (hemiplegia) — the  arm  and  leg,  with 
possibly  the  face  muscles  on  the  same  side,  being  thrown 
out  of  action ;  or,  more  commonly,  there  may  be 
paralysis  of  both  arms  or  both  legs  (paraplegia).  Not 
infrequently  hysterical  paralysis  affects  single  limbs, 
muscles,  or  groups  of  muscles  (monoplegia).  The  usual 
type  of  this  condition  is  paralysis  of  one  arm  following 
an  injury  which  has  not  really  produced  actual  physical 
damage    (brachial    monoplegia).      Accidents    in    which 


142  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

sudden  shock  occurs  with  considerable  emotional  stress 
frequently  produce  a  paralysis  of  this  type.  Mishaps 
with  motor-cars,  bicycles,  or  in  railway  trains,  are  thus 
productive  of  loss  of  movement  in  this  way  ;  whilst 
paralysis  of  an  arm,  for  example,  may  be  brought  about 
by  sudden  shock  produced  by  unexpected  contact  with 
a  strong  electrical  current,  or  other  violent  and  miexpected 
stimulation.  There  is  one  peculiar  form  of  limb  weakness 
which  deserves  special  mention  ;  in  this  there  is  ability 
to  move  the  limbs  whilst  the  patient  is  lying  down  with 
collapse  and  failure  to  control  movement  or  support  the 
body  as  soon  as  an  attempt  is  made  to  stand  up  or  walk. 
This  peculiar  condition  (astasia-abasia),  whilst  occa- 
sioning very  great  distress  to  those  thus  afEected,  never- 
theless calls  forth  an  amount  of  sympathy  out  of  all  pro- 
portion to  the  real  nature  of  the  case  ;  a  state  of  things 
which  is  particularly  disadvantageous  in  that  it  confirms 
the  invalid  in  those  very  morbid  self-suggestions  of 
paralysis  which  are  the  mainsprmgs  of  the  iUness  itself.^ 
Be  it  noted  that  facial  palsy,  in  effect  exactly  resembUng 
that  produced  by  cold,  ear  trouble,  or  other  condition 
damaging  the  facial  nerve,  may  occur.  Paralysis  of 
the  vocal  apparatus,  producing  complete  loss  of  voice 
(aphonia)  is  comparatively  common.  Equally  typical 
hysterical  manifestations  affecting  muscular  movements 
are  the  contractures.  The  common  type  is  that  of  a 
partially  or  completely  clenched  fist  which  resists  aU 
attempts  to  open  it,  and  if  of  long  duration  may  even 
remain  closed  during  the  administration  of  chloroform. 
Amongst  the  war  neuroses  we  shall  find  that  contractures 
are  fairly  common,  and  determined  in  their  locality  and 
extent  by  the  nature  of  the  wound  or  injury  which  has 
originated  or  accompanied  the  nervous  condition.  Wounds 
and  injuries  being  many  in  their  variety  and  distribution, 
the  hysterical  contractures  of  war  are  correspondingly 
various. 

^  See  also  Part  IV,  chap.  ii.  p.  28X. 


HYSTERIA  143 

Whilst  many  hysterics  are  crippled  by  weakness  and 
paralysis  there  are  some  whose  muscular  powers  are 
influenced  in  the  opposite  direction  ;  they  suffer  from 
rather  too  much  than  too  little  muscular  activity.  Such 
morbid  excitability  is  evidenced  by  a  variety  of  move- 
ments which  are  beyond  the  control  of  the  sufferer. 
Tremors  and  tremblings,  jerks  and  spasms  of  all  kinds, 
convulsive  actions  in  various  parts  of  the  body,  some- 
times general  restlessness,  occasionally  conditions  re- 
sembling St.  Vitus  dance  occur  at  one  time  or  another  as 
hysterical  manifestations.  Amongst  the  explosive  muscu- 
lar phenomena  of  this  malady  must  be  included  as  facial 
accompaniments  the  violent  outbursts  of  crying  and 
laughing  which  not  infrequently  mark  the  hysteric,  and  in 
the  same  order  must  be  mentioned  the  peculiar  running 
or  jumping  actions,  and  the  curious  grimaces  sometimes 
seen  in  hysterical  people. 

For  centuries  one  characteristic  of  hysteria  has  excited 
the  wonder  of  all  who  have  investigated  this  protean 
disease,  and,  unfortunately  for  those  suffering  from  it,  has 
formed  the  great  sign  by  which  the  witch-hunters  recog- 
nized their  prey.  One  refers  to  the  curious  patches  of 
numbness  and  diminished  sensibility  which  so  often 
occur  as  hysterical  phenomena.  When  zealous  villagers 
aflame  with  excitement  sought  out  the  children  of  the 
devU  they  were  confirmed  in  their  suspicions  when  some 
unfortunate  creature  suspected  of  traffic  with  the  powers 
of  darkness  was  found  to  be  insensible  to  proddings  ia 
various  parts  of  the  body.  These  "witch's  marks  "  were 
hailed  as  the  sign  manual  of  Satan,  and  often  enough  the 
sufferer  from  hysterical  anaesthesia  was  lucky  if  she  were 
led  to  the  nearest  pond  for  a  ducking  instead  of  to  the 
stake.  Times  change,  and  witch's  marks,  once  potent  to 
rouse  popular  frenzy,  to-day  excite  the  interest  of  the 
medico-psychological  laboratory  rather  than  of  the 
countryside.  Nevertheless,  the  disturbance  of  sensation 
that   was   a   mystery  to  priests  and  parishioners   in  a 


144  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

more  ignorant  age  still  remains  a  mystery  to  modern 
science. 

Curiously  enough,  the  loss  of  ability  to  feel  anything 
touching  the  skin,  so  characteristic  of  hysteria,  quite 
commonly  affects  an  arm  or  leg  just  as  if  a  glove  or  stock- 
ing of  non-conducting  material  were  drawn  over  it. 
When  this  occurs  the  area  of  anaesthesia  can  be  readily 
mapped  out  and  -Rdll  be  found  to  have  a  regular  upper- 
border  just  as  does  a  glove  or  stocking.  On  all  fours  with 
this  lessened  skin  sensitiveness  one  often  finds  duninished 
sensibility  of  the  throat  and  eye  ;  so  much  so  that  an 
observant  medical  man  will  sometimes  become  aware  of 
the  hysterical  basis  of  an  illness  when  on  examining  the 
throat  he  finds  that  manipulations  which  would  occasion 
retching  and  choking  under  ordinary  circumstances 
cause  no  discomfort  ;  or  when,  on  touching  the  eye-ball, 
the  invalid  does  not  flinch.  Amongst  disturbances  of 
sensation  must  be  included  neuralgic  pains.  These  may 
be  widespread  in  distribution,  and  not  infrequently  felt 
in  the  joints.  Sometimes  there  are  definite  areas  of  the 
body  in  which  pain  is  felt  constantly  ;  also  a  state  of 
increased  sensitiveness  of  the  skin  (hypersesthesia)  is 
quite  common,  so  that  the  slightest  touch  is  felt  as  a 
painful  stimulus. 

It  is  just  as  difficult  to  explain  how  it  is  that  without 
any  physical  cause  people  may  become  blind  and  deaf, 
or  divested  of  their  ability  to  taste  and  smell,  as  it  is  to 
give  definite  unchallengeable  reasons  for  the  patches  of 
ansesthesia  referred  to  above.  The  modem  theory 
of  hysteria  propounded  by  the  French  school  under 
the  leadership  of  Babinski  holds  that  these  phenomena 
are  not  inherent  in  the  disease  itself,  hut  are  alivays 
due  to  suggestion  from  without  ;  an  interesting  hypothesis 
that  can  be  discussed  at  length  when  we  come  to  sum 
up  the  basis  of  the  illness.  It  is  noteworthy  that, 
although  the  disorders  of  sensation — including  peculiar 
variations  in  regard  to  sight,  hearing,  smell,  and  taste 


HYSTERIA  145 

that  one  comes  across  in  examining  hysterical  patients — 
are  fairly  common  in  civil  life,  the  war  has  afforded  us 
much  greater  opportunities  of  studying  these  derange- 
ments of  the  special  senses  than  we  have  ever  had  before, 
as  will  be  observed  when  the  question  of  war  neuroses 
comes  up  for  detailed  consideration. 

It  has  already  been  pointed  out  that  hysteria  is  a  great 
imitator  of  other  diseases,  and,  if  this  is  borne  in  mind, 
we  shall  never  be  surprised  at  those  remarkable  conditions 
of  ill-health  in  which  without  any  ascertainable  physical 
foundation  most  serious  changes  of  function  and  struc- 
ture occur,  suggesting  that  there  must  be  present  some 
grave  underlying  physical  trouble.  Heart,  lungs,  abdo- 
minal organs,  skin,  and  general  processes  of  wear  and 
tear,  all  come  within  the  scope  of  the  interfering  influence 
of  hysteria  from  time  to  time.  Gastric  ulcer,  anaemia, 
consumption,  tuberculous  disease  of  the  joints,  intes- 
tinal disorders,  and  progressive  degeneration  of  the  brain 
and  spinal  cord  are  aU  imitated  by  hysteria  with  con- 
summate skill.  From  time  to  time  doctors  are  puzzled 
by  an  attack  of  persistent  fever  in  which  day  after  day 
there  is  a  rise  of  temperature  to  as  much  as  106°  F.  when 
no  cause  is  to  be  found,  and  eventually  the  whole  thing 
turns  out  to  be  a  freak  of  hysteria.  Finally,  one  remem- 
bers that  this  extraordinary  condition  has  for  ages  been 
known  as  a  producer  of  "living  skeletouE."  Hysterics 
sometimes  manage  to  live  on  incredibly  small  quantities 
of  food,  but  in  the  process  become  so  reduced  in  weight 
and  flesh  that  it  is  marvellous  how  body  and  soul  manage 
to  maintain  company.  A  few  years  ago  one  of  these 
living  skeletons  flgured  prominently  when,  at  a  famous 
Well  of  Heahng,  a  wonder  cure  occurred  as  a  result  of  the 
psychological  stimulus  provided  by  the  ceremonies 
there. 

Last,  but  not  least,  in  our  review  of  the  general  signs 
of  hysteria  may  be  taken  the  strange  attacks  that  so  often 
move  hysterical  persons.     Comparatively  simple  emo- 


146  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

tional  attacks  in  whicli  the  sufferer  is  carried  away  by  a 
fit  of  laughing  or  an  outburst  of  weeping  are  well  known  ; 
still  these,  together  with  outbreaks  of  bad  temper  and 
excitement,  although  common,  constitute  but  the  minor, 
manifestations  of  the  hysterical  attack.  On  the  other 
hand,  the  great  convulsive  seizures,  representing  a  tre- 
mendous storm  sweeping  over  mind  and  body,  have  from 
earliest  times  of  recorded  history  occasioned  great  interest. 
Responsible  for  many  wild  scenes  in  medieval  days,  the 
cause  of  many  strange  riots  and  religious  happenings,  the 
despair  of  physicians,  and  the  terror  of  respectable  persons  ; 
represented  on  the  stage,  pictured  in  poetry,  and  described 
in  a  thousand  works  on  all  subjects,  it  has  remained  for  a 
great  physician  of  our  own  day  to  interpret  and  describe  in 
classical  terms  the  features  of  these  strange  seizures.  It 
was  the  great  Charcot  who  described  for  all  time  the 
characteristics  of  "  la  grande  hysteric,"  and  it  was  through 
those  demonstrations,  to  see  which  the  medical  world 
flocked  to  Paris  some  years  ago,  that  the  modem  medical 
man  became  acquainted  with  the  full  significance  of  the 
great  hysterical  convulsions.  Certainly  in  recent  times 
no  clinic  has  been  so  prolific  of  the  real  thing  as  that 
directed  by  Charcot,  it  being,  of  course,  unquestionably 
by  a  constant  process  of  suggestion — maintained  at  that 
time  entirely  without  the  knowledge  of  the  physicians 
concerned — ^that  the  phenomena  became  so  multiplied 
and  magnified.  But  that  this  occurred  does  not  in  the 
least  detract  from  the  masterly  descriptions  which  eman- 
ated from  Charcot's  clinic,  whilst  in  one  respect  it  hap- 
pily or  unhappily  accentuated  those  particular  expres- 
sions of  hysteria  with  which  we  are  now  concerned. 

Briefly,  the  grand  hysterical  attack  consists  of  three 
stages.  There  is  a  period  of  general  unrest  in  which  the 
individual  influence  becomes  gradually  stored  up  with  a 
sense  of  something  being  about  to  happen.  Next,  after  a 
matter  of  minutes,  hours,  or  days  as  the  case  may  be,  the 
body  becomes  strung  up  into  a  state  of  great  tension. 


HYSTERIA  147 

It  is  then  that  certain  well-known  bodily  attitudes  are 
assumed,  and  the  hysteric  throws  herself  as  if  sculptured 
in  marble  into  one  of  those  strange  positions  of  which  the 
"  crucifixion  "  attitude  and  "  ecstatic  "  pose  are  famous. 
In  the  former  the  legs  are  extended,  the  head  bent  over, 
the  arms  thrown  out  as  if  the  body  was  being  stretched 
on  a  cross.  When  the  position  of  ecstasy  is  assumed  the 
attitude  is  that  of  being  absorbed  in  prayer.  On  bended 
knee  the  hysteric  throws  up  her  clasped  hands,  and  with 
wide  staring  eyes  and  uplifted  face  shows  every  sign  of 
intense  devotion.  That  at  this  stage  she  may  dream 
dreams,  see  visions,  or  hear  voices,  adds  to  the  interest  of 
the  psychological  problem  to-day  just  as  it  roused  wonder- 
ment, admiration,  jealousy,  enmity,  or  fear  in  priests  and 
people  in  times  gone  by. 

Following  the  positional  stage  there  is  a  period  of 
terrible  convulsion,  in  which  the  sufferer  throws  herself 
about  screaming,  kicking,  and  fainting  ;  and,  whilst  a 
hundred  different  poses  are  assumed,  every  now  and  then 
the  main  position  previously  noted  is  taken  up  for  a  short 
time.  During  this  stage  of  the  grand  seizure  anything 
may  happen.  Under  such  an  influence  the  hysteric 
becomes  a  great  actress,  and  may  portray  such  scenes  of 
agony  and  passion  as  are  only  dreamed  of  by  professional 
tragedians  in  their  most  exalted  moments.  It  is  here 
that  suggestion  plays  such  an  important  part  in  in- 
fluencing action,  and  in  individual  instances  it  may  be 
difficult  to  iollow  the  train  of  suggested  thought.  Never- 
theless, there  is  often  sufficiently  obvious  evidence  as  to 
the  nature  of  many  of  the  ideas  underlying  the  dramatic 
performance  witnessed. 

After  this  stupendous  nerve-storm  comes  gradually  a 
calm.  Sometimes  a  wild  cry  may  end  the  attack.  Often 
enough  nothing  further  occurs  that  is  worthy  of  note,  but 
on  the  other  hand,  it  sometimes  happens  that  a  strange 
state  of  mind  persists  for  some  little  time  after  the  con- 
vulsion.    When  this  is  so  a  variety  of  happenings  may 


148  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

occur.  It  is  in  this  period  that  one  witnesses  the  remark- 
able automatic  actions  which  often  place  the  hysteric  in 
a  false  position.  Automatism  may  lead  to  the  perform- 
ance of  such  habitual  actions  as  midi^essing  or  putting  on 
more  clothes  ;  of  walking  or  resting  ;  of  going  to  shops 
and  buying  things,  even  of  stealing  things,  without  the 
person  thus  under  subconscious  control  bemg  in  the  least 
aware  of  what  is  being  done. 

On  the  other  hand,  in  the  stage  following  the  convul- 
sion the  sufferer  will  often  pass  into  a  dream-state,  in 
which  she  rests  with  closed  eyes  for  days  at  a  time  as  if 
poised  between  life  and  death.  Under  such  circum- 
stances, the  hysteric  becomes  an  object  of  intense  interest 
to  wonder -seekers,  and  it  is  from  such  material  that  are 
made  the  reported  cases  of  persons  being  buried  alive 
without  food  or  drink  for  some  days  which  from  time  to 
time  excite  the  multitude.  Occasionally  the  showman 
has  had  his  chance  and  exploited  the  victim  of  hysteria  ; 
it  is  hard  to  blame  him  for  having  been  deceived  by  a 
phenomenon  that  has  puzzled  the  wisest  heads  of  all 
ages,  nor  for  his  anxiety  to  bring  his  wonderful  discovery 
of  "  living  death  "  or  "  trance  "  before  the  eyes  of  the 
astonished  world. 

Illustrative  notes. — ^The  following  extracts  illustrate  some 
of  the  more  common  manifestations  of  hysteria  : 

1.  A  young  girl,  after  a  railway  accident,  in  which  her 
left  shoulder  was  bruised,  experienced  weakness  in  her 
left  arm,  which  readily  became  tked  and  "  gave  way 
readily," 

2.  A  widow  had  recently  great  anxiety  and  grief  through 
her  husband's  fatal  illness.  Experienced  difficulty  in 
swallowing  eohd  food  ;  indigestion  with  distressing 
flatulence  ;  jtimpiness  of  limbs  and  head,  particularly 
movements  of  the  head  before  speaking. 

3.  A  young  woman,  aged  25,  was  very  dissatisfied  with 
life  and  complained  chiefly  of  mental  and  physical  fatigue  ; 
neuralgic  pain  in  the  head  ;    difficulty  in  vision  (could 


HYSTERIA  149 

only  read  very  large  type,  and  was  Bupposed  by  relatives, 
supported  by  medical  opinion,  to  be  "  going  blind  ") ; 
depression  at  times.  Examination  revealed  no  organic 
disease,  but  there  was  distinct  diminution  in  the  field  of 
vision.  In  spite  of  the  bad  forecast  which  had  been 
given  she  gradually  improved  under  systematic  treat- 
ment in  which  mental  therapeutics  played  the  chief  part. 

4.  A  married  woman  for  some  years  had  been  affected 
with  functional  spinal  weakness,  so  that  she  was  unable 
to  stand  without  support,  owing  to  "  giving  way  " 
of  the  body  muscles  on  the  left  side.  Consequently,  was 
unable  to  get  about  without  immediately  falling  down. 
On  inquiry,  it  appeared  that  patches  of  anaesthesia 
(witch's  marks)  and  hjrpersesthesia  had  occurred  at 
times,  but  nothing  of  this  kind  was  to  be  found  on  examin- 
ation. A  very  interesting  case  in  regard  to  the  rapidity 
of  improvement  under  static  electricity  supported  by 
suggestion  and  persuasion. 

5.  A  school  teacher,  after  a  long  period  of  over-work, 
was  attacked  by  nervous  symptoms.  There  was  right - 
sided  weakness  said  to  vary  from  time  to  time  and  definite 
diminution  of  sensation  of  the  left  leg  as  compared  with 
the  right. 

6.  A  Government  employee,  after  a  long  period  of  over- 
work, complained  of  jumpitiess  of  limbs — attacks  of  nose 
bleeding — patches  of  numbness  and  pains  in  the  legs  and 
feet.  Examination  revealed  no  organic  disease,  but  there 
were  definite  patches  of  numbness.  Over  these  places 
there  was  a  feeling  that  the  skin  had  gone  "  to  sleep." 
One  was  at  the  back  of  little  and  fourth  fingers,  another 
about  two  inches  below  the  left  hip-joint  covering 
an  area  the  size  of  haK-a-crown  ;  excessively  sensitive 
to  pricks,  but  apparently  insensitive  to  deep  pressure. 
Also  on  the  lower  surface  of  left  big  toe  there  was 
weU  defined  insensitivity  to  both  prick  and  touch. 
Patient  was  of  a  nervous  and  introspective  temperament, 
inclined  to  be  depressed  and  to  withdraw  from  friends 


150  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

and  relatives.  Under  treatment  by  rest,  persuasion  and 
static  electricity  made  a  good  recovery  ;  normal  sensa- 
tion retm'ning  in  the  various  patches. 

7.  Girl,  aged  17,  previous  to  being  seen  had  been 
troubled  by  loss  of  voice  and  hoarseness,  particularly 
after  singing.  After  a  holiday  she  recovered  the  strength 
of  her  voice,  but  towards  the  end  of  the  term  much  in- 
convenienced, and  her  future  career  greatly  jeopardized. 
On  this  account  had  been  told  by  a  doctor  she  must 
change  her  vocation.  No  organic  abnormality  was  found. 
She  was  perfectly  healthy  both  mentally  and  physically. 
After  explanation  and  firm  conversational  persuasion 
she  had  very  little  subsequent  trouble,  being  only  bothered 
occasionally  after  singing. 

8.  A  young  man  lost  the  use  of  an  arm  after  an  electri- 
cal shock.  On  examination  it  was  found  that  there  was 
loss  of  sensibility  (anaesthesia)  of  the  whole  limb.  Ex- 
haustive investigation  failed  to  demonstrate  any  sign  of 
physical  injury.     Subsequently  recovered. 

9.  A  young  woman  suffered  from  mental  excitement 
and  convulsive  attacks.  In  one  of  these  she  was  seen  to 
throw  herself  on  the  ground  and  go  off  into  a  trance -like 
state,  in  which  her  body  and  limbs  assumed  the  classical 
"  crucifixion  attitude."  (See  account  of  hysterical 
attacks.) 

10.  A  young  woman  had  been  going  about  on  crutches, 
being  unable  to  use  the  right  leg  for  walking  or  standing. 
Complained  of  pain  and  intense  throbbing  sensation 
below  the  knee.  Both  the  patient  and  relatives  reported 
occasional  swelling  of  knee.  This  case  is  particularly 
interesting  in  that  she  had  been  sent  to  London  with  a 
view  to  having  her  right  leg  taken  off  above  the  knee 
for  supposed  tubercular  disease.  Electricity  and  sug- 
gestion were  advised.  As  a  result  there  was  immediate 
improvement,  and  within  a  fortnight  she  was  able  to 
walk  without  crutches. 

l\.  A  young  woman  complained  of  involuntary  move- 


HYSTERIA  151 

ments  of  "neck  muscles,"  disturbed  sleep,  headaches, 
palpitation  and  hot  flushes.  .  Said  that  her  head  twisted 
round  to  the  left  involuntarily  and  remained  there  some 
minutes  during  which  she  was  unable  to  move  it  back 
again.  Recently  whilst  practising  elocution  suddenly 
had  an  attack  in  which  she  became  semi-conscious,  whilst 
the  head  twisted  as  usual ;  also  said  that  the  front  of  the 
head  felt  as  if  "  the  thinking  part  "  was  full  up  with  a 
gathering  of  water. 

12.  A  young  girl  had  been  suffering  from  attacks  of 
loss  of  voice  (aphonia).  Unable  to  speak  even  in  a  whis- 
per.   Cured  by  two  or  three  suggestion  treatments. 

13.  ^  married  woman,  suffering  from  attacks  of  cata- 
lepsy of  half -hour's  duration,  sometimes  more  frequent 
than  others,  but  usually  more  common  about  the  time  of 
the  period.    Also  indigestion,  inertia,  headache. 

14:.  A  middle-aged  woman  sought  advice  for  aphonia  with 
vocal  cord  spasm  of  four  years'  duration.  Apparently 
had  had  previously  an  attack  of  functional  paralysis  in 
the  right  arm.    Treated  psychologically  without  success. 

15.  ^  girl,  aged  20,  troubled  with  neuralgia  of  the  left 
hip  (pain  constant)  following  upon  a  fall.  No  organic 
lesion  to  be  found.  Treated  by  suggestion  with  imme- 
diate relief.  Three  treatments  given.  No  subsequent 
return  of  pain. 

16.  A  married  ivoman,  troubled  with  general  nervous- 
ness, fatigue,  disturbed  sleep,  and  morning  sickness. 
History  by  medical  man  that  she  had  suffered  from 
subjective  symptoms  for  some  time,  and  on  one  occasion 
had  exhibited  patches  of  numbness  and  insensitivity  to 
pain. 

17.  A  man  suffered  from  attacks  in  which  he  ex- 
perienced numbness  of  one  or  other  limb,  with  simultane- 
ous sense  of  confusion  as  to  locality. 

18.  ^  young  woman  with  a  history  of  two  years'  alco- 
holism. The  chief  interest  in  this  case  was  the  occurrence 
of  catalepsy.     According  to  report  of  medical  man,  in 


152  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

these  attacks  she  lay  rigid  and  still ;  pale  with  very  shallow 
breathing;  "like  a  corpse,"  according  to  sister.  Duration 
of  each  several  hours  as  a  rule.  Formerly  attacks 
ensued  nearly  every  day,  but  latterly  at  intervals  of  a 
few  months. 

19.-4  young  woman  apparently  suffered  from  ulcer  of 
the  stomach.  Pain  and  tenderness,  constant  sickness 
directly  after  taking  food ;  frequently  "  bringing  up 
blood."  White  furred  tongue.  Lay  in  bed  with  legs 
drawn  up  ;  said  that  this  attitude  relieved  pain.  A  few 
days  later  patient  complained  of  pain  being  very  bad. 
Careful  examination  showed  diminished  sensation  of  skin 
of  arms  and  legs,  also  considerable  limitation  of  fields  of 
vision  laterally.     Subsequently  diagnosed  as  hysteria. 

20.  A  woman  complamed  of  attacks  of  emotional 
excitement.  Pains  and  tinghngs  in  arms  and  hands. 
Occasional  attacks  ia  which  she  "lost  herself."  Mental 
and  physical  fatigue.  Made  good  progress  under  treat- 
ment, but  relapsed  through  over -work. 

21.  Unmarried  woman  sought  advice  for  mental  and 
physical  fatigue  and  general  nervousness.  Very  self- 
centred.  Functional  aphonia.  Appeared  to  be  a  suitable 
case  for  treatment  by  suggestion,  but,  as  a  matter  of  fact, 
the  method  was  unsuccessful,  as  was  aU  else  tried. 


CHAPTER  VI 

MULTIPLE  PERSONALITY 

A  simple  case — Morbid  desire  for  notoriety — Dual  personality — An 
interesting  problem — Consequences — Alternating  personality — The 
case  of  Felida  X — A  clergyman's  experience — Loss  of  memory— 
The  famous  Sally  Beauchamp — Dr.  Morton  Prince's  analysis — 
Professor  Janet's  investigations — Simulation  of  demoniacal  posses- 
sion— ^Dangers  of  dissociation. 

OOME  years  ago  great  interest  was  aroused  by  a  case 
KJ  in  which  an  entirely  innocent  individual  was  actually 
imprisoned  on  a  charge  of  writing  anonymous  letters 
making  all  sorts  of  dreadful  statements  about  a  young 
woman.  In  the  course  of  the  trial  it  suddenly  transpired 
that  the  supposed  victim  of  this  anonymous  corre- 
spondence had,  indeed,  written  the  communications 
herself  !  Once  this  was  discovered  it  was  not  difficult  to 
find  medical  and  other  evidence  that  she  was  subject  to 
hysteria  and  had  suffered  in  previous  years  from  hysteri- 
cal disturbances.  Whether  or  not  this  unfortunate  young 
woman  became  for  the  time  being  dominated  by  a  secon- 
dary personality  was  not  made  clear  ;  probably  it  was 
not  a  case  of  dual  personality,  but  rather  an  example  of 
that  hysterical  mental  state  which  causes  those  influenced 
by  it  to  seek  notoriety  at  all  costs.  When  possessed  by 
such  a  morbid  and  furious  desire  to  be  known  to  the 
whole  world  the  hysteric  regards  neither  her  own  charac- 
ter nor  the  honour  of  those  dragged  into  her  schemes. 
From  time  to  time  innocent  and  unsuspecting  persons 
have  aspersion  cast  on  their  fair  name  by  hysterical 
women.  Curiously  enough,  the  mentally  deranged  fame- 
eeeker  at  times  endeavours  to  drag  down  into  the  mud 

153 


154  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

a  man  to  whom — quite  unbeknown  to  himself — she  has 
taken  a  great  fancy.  It  seems  that  realization  of  the 
futility  of  her  amorous  propensities  leads  to  a  violent 
reaction  which  seeks  merely  to  destroy,  and  in  destroy- 
ing to  bring  herself  into  the  limehght  of  publicity. 

Reference  to  such  cases  leads  us  directly  to  further 
consideration  of  the  problem  of  dual  personality  ;  the 
occurrence  of  which  is,  indeed,  one  of  the  most  extra- 
ordinary of  all  the  many  remarkable  manifestations 
of  hysteria.  Certain  temperaments  are  predisposed  to 
the  exhibition  of  what  is  termed  by  medico-psycho- 
logists "multiple  personality,"  which  means  that  they 
are  liable  to  exhibit  at  times  such  widely  differing  charac- 
teristics as  to  constitute  separate  individualities.  That 
is  to  say,  the  victim  of  this  temperament  may  appear  to 
one  set  of  people  and  under  one  set  of  circumstances  a 
perfectly  good  -  natured  and  healthy  -  minded  person, 
whilst  in  another  place  or  at  another  time  he  or  she  may 
manifest  all  the  evidences  of  a  bad-tempered  and  morbid 
disposition. 

In  extreme  cases,  of  which  numbers  have  been  reported 
and  examined,  the  change  of  personality  is  such  that  at 
different  periods  different  names  even  are  assumed,  and 
sometimes  different  occupations  pursued  ;  whilst  living 
an  ordinary  Hfe  to  all  outward  appearances,  the  subject 
of  this  strange  condition  is  at  the  same  time  pursuing  a 
second  life  hidden  from  friends  and  relatives.  Indeed, 
sometimes  the  subject  of  dual  personality  actually 
deceives  herself  as  to  what  is  going  on  ;  thus,  whilst 
obsessed  by  the  idea  of  the  second  personality,  she  may 
do  things  wilfully  intended  to  deceive  the  self  which  she 
recognizes  as  her  ordinary  self,  but  yet  as  a  separate  self, 
and  vice  versa.  And  so  it  is  that  from  time  to  time  some 
one  who  is  respected  and  known  as  a  straightforward, 
kindly,  honourable  young  woman,  is  suddenly  found  to 
be  the  author  of  libellous  postcards  or  anonymous  letters 
which  have  persecuted  a  whole  district.     Often  enough 


MULTIPLE  PERSONALITY  155 

the  double-faced  dealing  is  not  recognized  as  a  mani- 
festation of  mental  illness,  but  regarded  as  a  form  of  moral 
perversion,  for  which  the  individual  concerned  is  reaUy 
responsible.  As  a  matter  of  fact,  the  victims  of  hysteria 
and  double  personality  are  not  responsible  for  their 
actions.  Where  the  spHt  or  division  between  the  two 
personahties  shown  is  complete,  the  hysteric  thinks 
and  behaves  as  one  individual  at  one  time  and  an- 
other at  another,  without  there  being  any  correlation 
between  the  two  mental  states.  Doctors  who  have 
much  to  do  with  nervous  and  mental  cases  are  familiar 
with  patients  in  whom,  without  there  being  a  complete 
split  of  personality,  two  entirely  different  characters 
are  exhibited  at  different  times.  A  common  example 
is  that  of  the  young  woman  who,  outside  her  own  family,  is 
sweet  and  lovable, — famous  for  her  cleverness  and  careful 
thought  for  others, — whilst  at  home  she  is  subject  to 
most  violent  outbursts  of  ungovernable  fury,  and  suffers 
from  attacks  in  which  the  violence  of  her  actions  is  only 
equalled  by  the  coarseness  of  her  language.  Such  outbreaks 
are  for  the  most  part  entirely  beyond  the  control  of  the 
individual  concerned,  and  represent  a  sudden  ascendancy 
in  the  mind  of  passionate  ideas,  which  for  the  time  being 
possess  the  whole  mental  field.  In  very  bad  cases  the 
terrible  anger  and  physical  violence  are  so  great  that  the 
sufferer  throws  herself  on  the  ground,  writhing  with 
contorted  limbs  and  twisting  her  face  into  horrible 
expressions. 

Some  understanding  of  the  subject  may  be  arrived  at 
if  one  reduces  it  to  its  simplest  terms,  and  considers  the 
case  of  a  man  who  has  received  a  blow  on  the  head, 
or  for  the  time  being  is  the  victim  of  poisoning  by  a 
drug  which  excites  the  brain.  As  is  well  known,  under 
these  circumstances  a  gap  in  memory  may  occur,  so  that 
for  a  short  while  life  is  approached  from  a  new  point  of 
view,  usually  abnormal  when  judged  by  common  stan- 
dards of  conduct.    The  holiday-maker  who  worships  too 


166  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

devotedly  at  the  shrine  of  Bacchus  may  for  a  few  hours 
behave  in  a  manner  entirely  different  from  the  ordinary, 
and  this  without  exhibiting  any  of  the  recognized  signs 
of  drunkenness.  As  he  comes  to  himself  memory  brings 
it  home  to  him  that  his  conduct  is  strange,  and  leads  his 
will  to  take  up  again  the  rems  of  government  which  were 
slipping  from  his  grasp.  Should  the  dour  and  parsimonious 
individual,  who  has  for  the  time  being  become  benevo- 
lent and  happy-go-lucky  through  taking  a  few  glasses  of 
wine,  now  be  unable  to  regain  the  memory  of  his 
previous  mode  of  living,  he  might  persist  m  the  new 
personality.  Similarly  on  a  minor  scale  unexpected  good 
news,  the  sudden  acquirement  of  wealth,  or  realization  of 
duty  may  work  marvellous  changes.  Where  the  new 
characteristics  do  not  persist,  but  only  appear  from  time 
to  time,  then  we  have  a  definite  example  of  "  alternating 
personality." 

One  of  the  most  extraordinary  cases  of  alternating 
personality  ever  recorded  was  that  of  Felida  X,  investi- 
gated by  a  well-known  French  psychologist  some  forty 
years  ago.  Here  was  an  instance  in  which,  at  the  age  of 
fourteen,  a  girl  more  or  less  suddenly  changed  her  dis- 
position and  became  a  new  being.  After  a  time  the  new 
personality  was  lost,  and  the  original  one  assumed  again, 
an  interesting  point  being  that  as  Felida  II  she  remem- 
bered Felida  I,  but  in  her  normal  state  (I)  she  knew 
nothing  of  her  secondary  personality.  The  great  dis- 
advantage to  this  individual  was  that  the  changes  would 
sometimes  come  on  with  startling  rapidity  ;  and  when 
living  as  FeUda  I  she  would  suddenly  find  herself  in 
surroundings  very  confusing  to  her,  because  she  could 
not  remember  the  circumstances  that  had  led  up  to  her 
then  position,  for,  as  just  mentioned,  Felida  I  knew 
nothing  of  the  life  of  Felida  II.  The  conclusion  of  the  case 
was  equally  interesting,  because  when  she  was  between  forty 
and  fifty-five  years  of  age  she  one  day  became  Felida  II, 
and  remained  as  such  for  the  remainder  of  her  days. 


MULTIPLE  PERSONALITY  157 

A  still  more  interesting  and  astounding  case  of 
alternating  personality  was  that  of  an  American  clergy- 
man, whose  experiences  were  carefully  investigated  by 
the  late  Professor  WiLLLam  James  and  other  eminent 
persons  interested  in  these  matters.  The  Rev.  A.  B. 
became  a  clergyman  at  about  the  age  of  thirty,  and 
took  missionary  work  in  his  own  country,  preaching 
from  town  to  town.  One  day  he  drew  money  from 
his  bank  to  make  a  certain  purchase,  transacted  some 
business,  and  got  into  a  tram-car.  Having  done  this,  he 
apparently  lost  knowledge  of  himself,  so  to  say,  and 
nothing  was  heard  of  him  for  a  couple  of  months,  when 
he  suddenly  found  himself  the  proprietor  of  a  small 
general  shop  in  a  town  far  from  that  in  which  he  remem- 
bered having  taken  the  tram-car.  He  said  then  that  his 
name  was  the  Rev.  A.  B.,  that  he  did  not  know  the  town 
he  was  in,  nor  how  he  got  there,  and  that  how  it  was  that 
he  had  apparently  become  the  proprietor  of  a  shop  in 
the  name  of  Brown  surpassed  his  comprehension.  Natur- 
ally, everyone  thought  he  was  mad,  including  the  doctors 
who  were  asked  to  see  him.  However,  the  distracted 
clergyman  insisted  upon  telegraphing  to  his  alleged 
friends,  and  in  a  short  time  one  of  his  relatives  came 
along  and  identified  him.  What  he  did  in  the  interval 
between  taking  the  car  at  one  town  and  arriving  in 
another  no  one  could  ascertain.  But  the  undoubted 
fact  remains  that  the  Rev.  A.  B.  did  arrive  at  the  second 
locahty,  and  possess  himself  of  a  business  in  which  he 
behaved  as  a  perfectly  rational  shopkeeper,  making  his 
living  and  conducting  his  affairs  in  the  name  of  Brown 
for  some  little  time.  Amongst  other  features  of  interest  in 
this  case  was  the  circumstance  that  Mr.  "  Brown  " 
attended  a  local  church,  and  at  a  devotional  meeting  made 
a  speech,  during  which  he  actually  gave  an  account  of 
something  which  had  happened  when  he  was  the  Rev. 
A.  B.,  without  recalling  his  real  individuahty. 

Something  of  the  same  kind,  but  of  a  far  less  dramatic 


158  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

character,  was  once  brought  to  the  notice  of  the  writer 
in  the  case  of  a  man  engaged  as  a  clerk  in  London,  who 
set  out  for  his  office  one  morning,  and  some  days  later 
wandered  into  a  provincial  hospital  sixty  or  seventy 
miles  away,  saying  he  did  not  know  who  he  was  nor  where 
he  had  come  from.  Gradually  memory  returned  and 
identification  was  secured.  This  individual  had  evidently 
lived  for  two  or  three  days  in  apparent  comfort,  although 
he  had  probably  walked  a  gTeat  many  miles,  in  the  guise 
of  a  secondary  personality,  without  doing  anything  to 
call  particular  attention  to  himself. 

Dr.  Morton  Prince,  a  well-known  American  psycho- 
logist, has  pubhshed  some  very  interestmg  mvestiga- 
tions  about  the  case  of  "  Sally  Beauchamp,"  a  secon- 
dary personality  who  has  thus  become  famous  in  the 
scientific  world.  In  this  case,  by  a  process  of  careful 
analysis,  aided  by  hynoptism,  Dr.  Prince  discovered 
that  an  unfortunate  girl  was  possessed  by  no  less  than 
five  and  possibly  more  distinct  personalities,  each  of 
which  appeared  to  have  very  little  understanding,  or, 
at  any  rate,  kindly  feeling  towards  the  others.  Thus  it 
is  that  where  a  temperament  is  capable  of  manifesting 
distinct  personalities,  Personality  II,  for  example,  may 
plan  a  plot  and  carry  out  a  series  of  vicious  acts  intended 
to  damage  PersonaHties  I  or  III,  and  so  forth,  as  the  case 
may  be.  In  Dr.  Morton  Prmce's  remarkable  case,  a 
Miss  Beauchamp  was  obsessed  by  a  personality  calling 
herself  SaUy,  who  manifested  intense  disUke  of  the  normal 
individual,  and  did  various  things  to  annoy  her.  Thus 
it  is  related  that  on  one  occasion,  when  Sally  was  in 
the  ascendant,  this  unfortunate  woman  went  out  and 
gathered  some  insects,  snakes,  and  other  creepy  things, 
and  put  them  into  a  box  addressed  to  Miss  Beauchamp — 
that  was,  of  course,  to  herself  as  the  normal  personahty. 
In  due  course  Miss  Beauchamp  came  to  herself,  received 
the  parcel,  and  was  terrified  to  distraction  on  reaUzing  its 
contents.    It  must  be  noted  that  here  the  same  woman, 


MULTIPLE  PERSONALITY  159 

as  Sally,  handled  live  things  that  were  most  obnoxious  to 
herself  as  the  real  Miss  Beauchamp.  The  possibilities  of 
such  JekyU  and  Hyde  combinations,  together  with  the 
misunderstandings  and  miseries  that  may  be  thereby 
occasioned,  are  sufficiently  obvious.  Trouble  is  particularly 
likely  to  arise,  where,  for  example,  a  young  woman 
obsessed  for  the  time  being  conceives  an  attachment 
to  one  of  the  opposite  sex,  of  whose  existence  in  her 
normal  state  of  mind  she  is  scarcely  aware. 

In  one  of  the  cases  of  the  remarkable  series  collected 
by  Professor  Janet,  of  Paris,  was  a  young  woman  known 
as  Leonie,  who  exhibited  many  extraordinary  features. 
Here,  not  only  was  a  second  Leonie  revealed  in  the  hyp- 
notic trance,  but  on  one  occasion  a  Leonie  III  appeared, 
who  was  quite  a  different  person  from  the  other  two.  It 
was  found  that  Leonie  II  had  not  arisen  in  the  course  of 
ordinary  Ufe,  but  because  in  early  years  this  girl  had 
permitted  herseK  to  be  the  subject  of  hypnotism  in  the 
hands  of  numerous  individuals,  who,  finding  her  very 
susceptible,  had  made  sport  of  her  for  many  years  with 
a  resulting  mental  dissociation.  Another  subject  investi- 
gated by  the  same  authority  was  a  girl  named  Lucie,  in. 
whom  also  three  personalities  were  revealed  ;  but  here, 
again,  the  change  did  not  occur  in  ordinary  life,  but  only 
as  the  result  of  experiment.  Janet  has  also  reported  an 
extraordinary  case  of  double  personahty  simulating 
demoniacal  possession  ;  and  further  serving  as  an  ex- 
ample of  his  own  psychological  acumen.  This  was  a  case 
in  which  a  man  called  Achille  was  obsessed  by  a  person- 
ality claiming  aU  the  powers  of  an  attacking  demon. 
The  curious  thing  was  that  the  subject  of  the  "  possession  " 
was  quite  unconscious  of  the  presence  of  the  invading 
personality,  so  that  when  the  latter  was  told  to  move 
AchiUe's  limbs  the  resulting  movements  were  made,  and 
greatly  surprised  the  man  concerned.  Professor  Janet's 
Bkill  in  curing  this  sphtting  of  personality  was  shown  by 
hie  final  experiment,  in  which  he  sought  to  hypnotiseTthe 


160    THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

patient.  Owing  to  the  difficulty  of  this,  he  hit  upon  the 
device  of  putting  it  to  the  obsessing  personality  that  it 
could  not  send  AchOle  to  sleep.  Fortunately,  the  split- 
o£f  part  of  this  man's  temperament,  which  was  then  in 
ascendancy  as  a  "  demon,"  carried  out  the  suggested 
idea  to  show  its  strength,  and  in  a  moment  Achille  went 
to  sleep.  Immediately  the  experimenter  made  the 
necessary  suggestions  to  bring  together  the  dissociated 
parts  of  the  victim's  mind,  and  a  cure  resulted. 

There  is  little  doubt  that  in  times  gone  by  the  cases 
of  supposed  demoniacal  possession,  which  our  ancestors 
sought  to  cure  by  a  combination  of  physical  violence 
and  spiritual  ministration,  were  often  instances  of 
double  personality.  At  one  time  it  was  the  practice  to 
plunge  the  victim  of  such  attacks  into  cold  water,  or 
to  beat  her  with  sticks,  after  which  resort  was  had 
to  the  services  of  the  Church  to  complete  the  cure. 
It  is  interesting  to  remember  this  in  view  of  the  fact 
that  at  the  present  time  the  medico-psychologist  re- 
commends the  physical  stimulus  of  electricity,  backed 
up  by  the  mental  effect  of  hypnotic  or  simple  suggestion, 
as  the  best  means  of  combating  the  evil  thing.  It  is 
certainly  true  that  a  secondary  personality,  manifesting 
itself  in  one  of  the  ways  indicated  above,  may  exhibit  the 
most  diaboHcal  characteristics,  and  plan  aU  sorts  of 
things  for  harming  the  invalid  himseK  or  those  about 
him.  From  the  practical  point  of  view  these  cases  are 
important  at  the  present  day,  when  so  much  attention  is 
being  given  by  educated  persons  to  the  production  of 
trance -states  in  connection  with  spiritualism  ;  because 
the  psychologist  who  has  studied  these  things  is  very  well 
aware  that  the  personalities  which  are  said  to  control  the 
medium  in  such  trance-states  may  be  nothing  more  than 
spHt-off  parts  of  his  or  her  personality,  which  assume  the 
characteristics  of  "  possessing  "  spirits,  and  the  mani- 
festation of  which  necessarily  becomes  intensified  through 
habit.    Whatever  may  be  the  final  verdict  of  science  upon 


MULTIPLE  PERSONALITY  161 

the  phenomena  of  the  spiritualistic  seance,  it  must  be 
borne  in  mind  that  every  one  who  seeks  to  cultivate  for 
himself  the  faculty  of  automatic  writing  or  automatic 
speaking,  either  when  in  a  semi-trance  or  during  waking 
life,  opens  the  way  to  a  splitting — dissociation — of 
personality  that  may  have  a  very  serious  bearing  on 
future  mental  health.  As  already  noted,  it  sometimes 
happens  that  a  shock,  physical  or  mental,  wiU  readjust 
things  so  that  the  "  split  "  no  longer  persists,  and  the 
personality  remains  constant  ;  but  the  psychologist 
of  to-day  rehes  mostly  on  the  effects  of  persuasion  or 
suggestion  to  bring  about  the  restoration  of  balance. 
Hypnotism  has  been  used  with  success  in  a  few  cases, 
but  the  difficulty  here  is  that  many  persons  afflicted  by 
disorders  of  personality  are  not  amenable  to  that  in- 
fluence. 


CHAPTER  VII 

WHAT  THEN  IS  HYSTERIA? 

The  hysterical  temperament — Its  characteristics — Deficient  powers 
of  attention — Morbid  emotionalism, — Abnormal  suggestibility — 
The  spoiled  child — Unhealthy  dreaminess — Vain  imaginings — 
"ViTiat  is  hysteria  ? — Discarded  \'iews — No  physical  basis  found — 
Babinski's  theory — Auto-suggestion- — Charcot — Janet's  hypothesis 
— The  Freudian  School — Other  theories. 

TO  suffer  from  hysteria  one  must  in  the  first  place  be 
hysterical ;  to  be  hysterical  one  must  come  from  a 
nervous  stock,  and  at  the  outset  of  our  inquiry  it  will  be 
as  well  to  note  straightway  those  particular  features 
which  obviously,  and  admittedly,  are  characteristic  of 
hysterics.  These  are  caprice,  emotional  instability,  poor 
attentive  power,  a  tendency  to  dreaminess,  and  inability 
to  refuse  ideas  strongly  presented  to  their  minds.  In 
other  words,  the  hysterical  temperament  is  characterized 
by  great  emotionalism,  abnormal  suggestibility,  and 
deficient  powers  of  attention.  Owing  to  the  latter  defect 
the  mind  of  the  hysteric  habitually  wanders,  and  a 
wandering  mind  invites  such  abnormal  mental  phenomena 
as  automatism,  visions,  day-dreams,  and  multiple  person- 
ality. How  very  much  these  particular  mental  attri- 
butes are  those  of  a  child !  Do  we  not  see  evidences 
of  the  ready  suggestibility,  the  quick  emotionalism,  and 
the  rapid  play  of  thought  from  one  object  of  interest  to 
another  displayed  by  our  little  ones  every  day  ?  The 
hysterical  mind  then  may  be  said  to  be  the  child  mind, 
but  whereas  the  latter  is  responsive  to  routine  processes 
of  education  and  so  has  minimized  for  it  the  danger  for 
its  limitations,  the  hysteric  is  not  commonly  subject  to 

162 


WHAT  THEN  IS  HYSTERIA  ?  163 

similar  beneficial  influences  and  suffers  from  lack  of  moral 
training.  Do  we  not  frequently  see  the  child  become  a 
hysteric  when  over-fond  but  foolish  parents,  loosening 
instead  of  tightening  the  reins  of  mental  control  owing 
to  some  noticeable  sensitiveness,  so  develop  their  spoiled 
child  into  one  of  those  young  terrors  with  which  doctors 
are  only  too  well  acquainted  instead  of  into  a  useful 
member  of  society  ?  Time  after  time  the  fate  of  a  child — 
whether  it  is  to  become  a  spoiled  and  impossible  fury  or  a 
useful  citizen — is  governed  by  a  chance  combination  of 
circumstances  which  in  these  days  should  never  be 
permitted  to  arbitrate  in  such  an  important  matter. 

Let  us  now  examine  the  particular  men.tal  charac- 
teristics of  hysteria  in  further  detail,  taking  the  abnormal 
emotionalism  first  of  all.  How  changeable  is  the  mood 
of  the  hysterical  person — so  sensitive  as  to  turn  every 
possible  remark  into  adverse  criticism,  so  morbid  as  to 
detect  supposed  slights  in  a  dozen  turns  of  ordinary 
conversation.  Violent  in  temper  if  thwarted,  and  yet 
passionate  in  passing  devotion  if  attracted,  the  hysteric 
lives  always  in  a  mental  maelstrom.  Storms,  showers, 
and  sunshine  pass  and  repass,  ever  shaking  into  greater 
instabihty  a  nervous  system  unfitted  at  the  outset  to 
bear  tremors  of  any  kind.  To  a-ttempt  to  follow  the 
emotional  vagaries  of  people  of  this  type  is  a  task  beyond 
ordinary  powers  of  observation  ;  it  is  difficult  enough  for 
the  psychological  expert  to  keep  touch  with  a  train  of 
thought  that  is  so  bewildering  in  its  wanderings  and 
versatile  in  its  expression,  but  it  is  quite  hopeless  for 
parents,  friends,  or  relatives  to  essay  this  task.  Do  they 
try  to  do  so  they  will  most  certainly  add  fuel  to  the 
flame,  and  sympathy  will  often  be  converted  into  harsh 
misunderstanding  by  the  mobile  thought  of  the  individual 
to  whom  it  is  addressed. 

Now  as  to  the  absent-mindedness  characteristic  of 
hysterical  persons.  One  has  not  to  be  long  in  contact 
with   those   of   hysterical    temperament    to    note    their 


164  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

incapacity  for  prolonged  attention.  In  conversation  or 
in  occupation  they  cannot  keep  to  the  point  for  long. 
Their  interest  wanders  along  aU  sorts  of  side  channels, 
and  it  is  difficult  for  them  to  pursue  a  sustained  line  of 
thought.  Watch  the  hysterical  girl  as  she  sits  over  her 
book.  For  quite  long  periods  she  reads  nothing,  the 
pages  may  be  turned  over  in  a  half-hearted  way  ;  more 
often  they  are  not  turned  at  all.  She  has  wandered  off 
into  the  land  of  make-believe  and,  content  with  a  passing 
array  of  satisfying  dreams,  is  lost  to  the  world  and  its 
hard  ways.  To  the  ordinary  individual  she  is  m  a  day- 
dream, a  brown  study,  a  reverie  ;  to  the  psychologist 
she  has  let  go  those  reins  of  conscious  control  which  it 
should  be  our  proudest  attribute  to  hold,  and  in  so  surren- 
dering her  powers  of  quick  judgment  lies  open  to  every 
passing  suggestion.  To  be  open  to  suggestion  in  this  way 
is  to  become  the  victim  of  nervous  manifestations,  the 
dupe  of  self-deceits,  and  the  prey  of  the  unscrupulous. 
In  such  a  state  of  mind  the  hysteric  is  quite  unable  ever 
to  perform  that  operation  of  intellectualizing  the  emotions 
that  is  desirable  for  all  who  have  to  take  a  practical  place 
in  daily  life.  She  never  inteUectualizes  her  emotions  ; 
on  the  contrary,  she  lets  them  run  riot  throughout  her 
responsive  body.  There  ha,ve  been  times  and  places 
where  a  fascinating  personality — and  the  vagaries  of  her 
emotional  make-up  frequently  make  the  hysteric  a 
fascinating  person  in  certain  moods — combined  with 
dreaminess  and  an  oracular  manner  have  made  the 
fortune  of  hysterical  people  who  have  been  elevated  into 
the  position  of  pythoness  or  prophet. 

Associated  with  the  constant  dreaminess  goes  a  sense 
of  dissatisfaction  with  surroundings.  Castles  built  in  the 
air  are  only  too  seldom  impotent  to  keep  out  "  the  slings 
and  arrows  of  outrageous  fortune."  Most  of  us  are  con-- 
tent  to  use  our  dream  castles  as  resting  places  in  which 
for  a  short  space  we  can  be  free  from  the  troubles  of  this 
present  time.     The  hysteric  wants  to  bring  her  dream- 


WHAT  THEN  IS  HYSTERIA  ?  165 

land  to  earth  ;  she  strives  to  materialize  her  dreams. 
Human  nature  is  such  that  it  is  quite  normal  for  us  in  our 
dreams  and  reveries  to  play  the  part  of  kings,  princes, 
and  governors.  Everyone  to  his  bent.  The  humble 
writer  pictures  himself  swaying  a  most  powerful  pen  ; 
dreams  of  the  day  when  his  next  volume  will  be  a  "  best 
seller."  The  struggling  artist  builds  his  castle  as  a  studio 
in  which  amidst  luxurious  surroundings  he  wiU  receive 
the  highest  in  the  land.  The  rising  lawyer  sees  himself 
in  the  full  bottomed  wig  and  splendid  gown  of  a  great 
judge.  The  soldier  becomes  the  general ;  the  sailor 
treads  the  quarter-deck  in  the  panoply  of  the  admiral. 
The  keen  politician  sees  himself  ushered  into  his  sove- 
reign's presence  to  receive  from  majesty  the  keys  of 
office.  All  these  things  and  more,  are  dreamed  by  day 
and  by  night,  but  their  dreamers  come  back  to  earth  and 
take  up  the  stem  task  of  the  moment  ;  to  pursue  undis- 
mayed the  hard  road  that  alone  leads  to  fame  and  fortune. 
All  but  the  castle-builder  of  hysterical  temperament  who 
will  not  be  put  off  ui  this  way.  She  wishes  to  be  a  queen 
for  always  and  not  the  queen  of  a  day-dream  only  ;  and 
"in  this  we  find  the  explanation  of  those  extraordinary 
aberrations  of  conduct  which  not  infrequently  horrify 
friends  and  startle  the  world.  To  originate  the  most 
fantastic  rumour  ;  to  tell  the  most  outrageous  lie  ; 
ruthlessly  to  take  away  someone  else's  character  ;  to 
steal ;  to  accuse  ;  to  resort  even  to  self-mutilation  ;  or 
to  carry  out  a  dramatic  act  of  specious — but  never  in- 
tended suicide  ;  such  are  the  ways  in  which  the  hysteric 
endeavours  to  transfer  the  limelight  of  her  dreams  to 
the  world's  stage.  What,  then,  is  hysteria  ?  Certainly  it 
cannot  be  said  that  the  conclusions  arrived  at  about 
hysteria  by  the  medical  schools  of  to-day  are  satis- 
factory. A  multitude  of  irreconcilable  opinions  are  held 
by  authorities  of  equal  eminence,  and  out  of  the  welter 
of  fact  and  theory  comes  no  clear  guiding  light.  Hysteria 
remains  the  great  enigma  of  medicine  and  psychology  ; 


166  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

as  always  fickle  in  feature,  uncertain  in  behaviour,, 
and  elusive  as  to  cause.  With  the  exception,  indeed, 
of  the  countless  hysterical  disorders  that  have  tem- 
porarily incapacitated  so  many  soldiers  and  sailors 
through  war-strain  and  shell-shock.  When  thus  occa- 
sioned hysteria  certainly  seems  fairly  weU  behaved, 
following  certain  lines  with  almost  monotonous  regu- 
larity and  yielding  to  treatment  so  well  that  the  majority 
recover  completely,  and  it  may  be  confidently  antici- 
pated that  the  minority  will  sooner  or  later  follow  them 
to  health. 

The  only  definite  step  forward  one  can  take  when 
theorizing  about  hysteria  is  to  discard  some  of  the 
old  views  that  clearly  were  based  on  misconceptions. 
There  is  no  object  to  be  served  by  reviewing  those  fancies 
of  past  days  which  have  been  decently  buried  and 
may  be  left  to  rest  with  those  wiseheads  that  originated 
them.  The  steady  procession  of  discarded  medical 
theories  to  the  graveyard  of  lost  reputations  makes  one 
pause  to  think.  To-day  the  bells  sound  as  cheerfully  and 
the  mourners  chatter  as  merrily  at  these  strange  funerals 
as  at  any  time.  Still  everyone  is  now  agreed  that  hysteria 
is  not  really  due  to  the  wandermgs  about  the  body  of 
certain  essential  organs  of  procreation ;  nor  do  we  any 
longer  believe  that  hysterical  people  are  possessed  of  the 
devil.  On  the  positive  side,  whilst  there  are  still 
some  who  seem  to  think  that  one  day  a  primary 
physical  cause  will  be  found  at  the  root  of  all  forms 
of  nervous  disorder,  including  even  hysteria  ;  for  the 
most  part  there  is  agreement  that  this  condition  is 
entirely  based  on  disturbances  in  human  mind.  On  the 
one  hand,  the  tendency  to  mind-wandermg — Pleading  to 
certain  thought -groups  apparently  getting  out  of  control, 
and  becoming  dissociated — and  on  the  other,  the  abnormal 
suggestibility  of  hysterical  people  taken  m  consideration 
with  their  excessive  emotionalism,  form  the  basis  of  the 
most  generally   accepted   modern   theories   of   hysteria. 


WHAT  THEN  IS  HYSTERIA  ?  167 

Indeed,  that  which  is  most  rapidly  gaining  ground  just 
now  is  that  hysterical  symptoms  are  solely  and  finally 
due  to  passing  "  suggestions  "  which  have  been  caught,  as 
it  were,  and  transferred  to  the  realm  of  action.  According 
to  this  idea,  which  has  been  most  diligently  fathered  by 
the  famous  French  neurologist,  Babinski,  hysteria  has 
no  identity  at  all  as  a  disease  or  nervous  disorder  ;  what 
we  find  is  the  result  of  particular  suggestions,  some  self- 
administered  by  the  patient,  some  coming  from  friends,  or 
even  from  the  doctor  himself  !  Followers  of  Babinski 
say,  in  effect,  that  we  are  all  potential  hysterics  ;  that 
according  to  our  degree  of  suggestibility  so  are  we  more 
or  less  likely  one  day  to  show  signs  of  what  is  known  as 
hysteria  !  An  American  authority  amusingly  writes 
that  "  everyone  has  hysterical  small  coin  in  the  bank  of 
his  personality." 

In  a  word,  the  suggestion  theory  says  that  when  a 
doctor  examines  a  hysterical  patient  he  can  find  practi- 
cally whatever  he  looks  for  unless  he  takes  the  very 
greatest  care  not  to  give  any  indication  of  what  he  is 
after.  Thus,  it  is  said  that  if  one  asks  the  patient,  "  Do 
you  feel  me  touch  you  ?  "  the  question  at  once  acts  as  a 
suggestion  that  one  rather  expects  a  negative  answer, 
and,  in  consequence,  the  part  in  question  is  actually 
found  to  be  insensitive.  This  modem  school  practically 
holds  that  Charcot  actually  manufactured — quite  un- 
knowingly, of  course — ^the  classical  types  of  hysteria 
which  have  become  so  familiar  to  us  from  the  experiments 
and  observations  under  his  direction  at  the  Saltpetriere 
hospital  in  Paris  some  few  years  ago.  Of  a  rather  different 
order,  but  stUl  centred  round  the  characteristic  of  ex- 
treme suggestibility,  is  the  theory  of  Janet,  which,  up  to 
quite  recently,  has  probably  had  more  modern  sup- 
porters than  any  other.  Janet,  another  brilliant  worker 
in  the  French  schools,  holds  that  the  hysteric  is  to  aU 
intents  and  purposes  a  hypnotized  person,  in  whom 
particular  sets  of  ideas  dominate  the  field  of  conscious- 


168  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

nese  on  their  owii  account  as  it  were.  Certainly  such  a 
supposed  "  dissociation  "  can  readily  be  invoked  to  ex- 
plain many  things  in  hysteria.  It  is  quite  true  that  the 
hysteric  often  seems  to  be  playing  a  part,  to  have  lost 
normal  personality  for  the  time  being  ;  witness  the 
"  grand  attacks,"  and  more  particularly  the  cases  of 
dual  and  multiple  personality  to  which  reference  has 
been  made.  Janet  started  from  the  observation  that 
hysterical  people  are  not  able  to  take  so  much  in  at  a 
time  as  others  ;  they  are  tired  in  mind  and  can  only 
grasp  a  proportion  of  what  is  presented  to  them  at  any 
given  moment.  He  evidenced  their  dreaminess,  and 
poverty  of  attentive  power  in  support  of  this.  Under 
these  cixcTunstances  the  supposition  is  that  the  hysteric 
attends  to  what  she  can  and  lets  the  rest  go.  Conse- 
quently, she  commonly  exhibits  such  signs  as  diminished 
sensibiHty  of  the  skin,  contraction  of  the  field  of  vision, 
and  so  forth.  In  the  realm  of  ideas  this  same  contraction 
of  consciousness  operates  so  that  she  neglects  some 
things  altogether.  But  so  weak  is  her  general  thought - 
control  that  such  neglected  thought-groups — ^perhaps 
suggested  from  without — actually  make  a  centre  of  their 
own  and  manifest  as  secondary  phenomena.  In  this 
way  a  secondary  personality  may  be  built  up  which 
at  times  dominates  and  excludes  the  normal  personality 
so  that  a  new  individual  seems  to  appear.  Thus  we  get 
the  remarkable  phenomenon  of  two  lives  lived  alterna- 
tively, to  which  attention  has  already  been  called.  In  a 
word,  the  hysteric  varies  from  the  normal  to  the  extent  to 
which  she  is  dominated  by  some  hypnotizing  idea.  Janet 
holds  that  the  hypnotic  state  and  the  hysterical  state  are 
the  same  thing.  To  free  the  hysteric  one  must,  there- 
fore— ^according  to  the  schools  of  both  Babinski  and 
Janet — ^free  her  from  the  false  beliefs  which  have  forced 
their  way  between  her  and  the  truth  of  things. 

Of  recent  years  the  school  of  Freudians  has  tried  to 
take    us    back    to    the    old    sex-theory.     Extraordinary 


WHAT  THEN  IS  HYSTERIA  ?  169 

as  was  the  ancient  sex  view  that  held  hysteria  to  be 
due  to  wanderings  of  the  womb  it  was  scarcely  as 
remarkable  as  its  modem  representative  which  finds  sex 
in  every  thought,  and  sex  in  every  action.  Awake  or 
asleep,  the  Freudians  haunt  us  with  sex.  Our  conscious 
lives  are  but  the  results  of  endless  struggles  with  sex- 
instincts  ;  our  conscious  thoughts  but  the  bubble  and 
froth  of  cauldrons  of  iniquity.  That  emotions  based  on 
sex  matters  disturb  all  human  beings  and  make  some  ill 
is  a  truism.  But  that  aU  nervous  troubles — ^hysteria 
amongst  them — have  a  sex  basis  is  an  extreme  view. 
Put  briefly,  the  theory  of  Freud  and  his  school  is  that 
ideas  of  a  sexual  order,  offensive  to  the  better  feelings  of 
the  individual,  arise  and  are  sternly  repressed.  Sub- 
sequently they  act  as  a  focus  of  irritation  in  subconsci- 
ousness and  give  rise  to  nervous  troubles.  The  man  who 
loves  and  is  unable  to  achieve  the  object  of  his  desires 
represses  his  passion,  and  then  lives  over  a  volcano  as  it 
were.  Other  conditions  favouring  it,  one  day  an  erup- 
tion will  occur  ;  some  day  an  explosion  may  shake  the 
very  foundations  of  his  reason.  There  is  a  good  deal  in 
this,  of  course,  but  whilst  it  may  be  an  explanation 
of  particular  cases  it  can  be  by  no  means  applied  in 
general.  The  exponents  of  psycho-analysis,  which  pro- 
fesses to  cure  the  disease  by  getting  rid  of  the  morbid 
focus  of  thought,  have  managed  to  attract  a  good  deal 
of  attention,  but  it  is  likely  that  the  high-watermark  of 
their  popularity  was  reached  some  time  since,  and  that 
the  tide  of  favour  wiU  now  recede  more  and  more  rapidly. 
Nevertheless,  it  leaves  behind  a  monument  of  literature, 
often  hysterical  in  more  senses  than  one,  which  will 
attract  the  degenerate  by  its  obscenity  long  after  the 
psychologist  has  turned  his  back  on  it. 

There  is  yet  another  of  the  many  views  of  hysteria 
which  may  be  mentioned  in  passing,  the  theory  that  the 
hysterical  mind  is  always  the  child-mind,  and  that  where 
the  individual  does  not  mentally  grow-up  as  it  were,  his  or 


170  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

her  reactions  to  Burroundings  become  those  that  we  call 
hysterical.  This  theory  ascribes  hysteria  to  "  the  per- 
sistence in  adult  life  of  the  childish  type  of  reaction  to 
the  facts  of  life.  It  is  a  mode  of  reaction  in  persons  of 
naive,  simple  and  elementary  mentality.  It  is  a  men- 
tality lacking  in  development  and  defective  in  judgment 
and  critique.  Such  mentalities,  when  placed  in  new 
environments  to  which  they  cannot  adapt,  or  adapt  with 
difficulty,  develop  the  hysterical  reaction.  They  go  back 
to  primitive  methods  of  escaping  difficulties."  ^ 

The  fact  is  the  truth  is  not  yet  known  about  this  pecu- 
liar variety  of  nervous  breakdown.  It  is  easy  to  theorize 
glibly  in  psychological  terms,  but  we  want  a  clearer 
understanding  of  what  we  mean  by  mind,  for  example, 
before  we  can  solve  these  problems  of  causation  satis- 
factorily. To  the  author  hysteria  seems  but  a  particular 
group  of  ailments  due  to  the  blmTing  of  true  appre- 
hension of  things  as  they  are  by  that  false  mind  which 
seems  continually  to  be  interfering  in  human  affairs ,  From 
what  we  vaguely  call  subconsciousness  there  come  to 
bother  us  all  sorts  of  false  beliefs,  and  many  of  these 
become  so  impressed  on  the  system  that  ill-health  results. 
The  key  to  the  problem  must  be  sought  in  the  evolution 
and  foundation  of  human  mind.  For  the  present  we  must 
see  through  the  mists  just  as  far  as  we  can,  being  thank- 
ful, indeed,  that  modern  investigations  have  certainly 
enabled  us  to  cope  more  satisfactorily  and  certainly  with 
hysterical  troubles  than  ever  before.  After  all,  to  cure 
without  knowing  why  is  perhaps  better  than  to  know  why 
without  curing. 

1  Osier's  System  oj  Medicine  ;  art.  "  Hysteria." 


PART  III 

THE  HYGIENE  OF  NERVE 


CHAPTER  I 

REDEESSING  THE  BALANCE 

Prevention  of  nervous  breakdown — A  special  problem  of  hygiene — Not 
a  question  of  destroying  germs — Modem  requirements  for  treat- 
ment— Difficulties  of  family  practitioner — So-called  nerve  tonics — 
Principles  of  physical  treatment — Electrical  methods — Massage — 
The  sick  soul — Morbid  introspection — Suggestion  of  right  ideas — 
Other  methods  of  treatment  through  mind — Functional  and  organic 
diseases — The  search  for  a  reliable  principle  of  mind  treatment — 
Prayer. 

THE  national  importance  of  nervous  breakdown,  as 
with  all  other  prevalent  forms  of  Ul-health,  lies  in 
the  steady  drain  of  energy  which  it  occasions.  But 
whereas  in  the  case  of  germ-borne  diseases  and  infec- 
tions^tuberculosis,  small-pox  and  typhoid  fever,  for 
example — ^the  solution  of  the  problem  rests  mainly  in 
methods  of  destroying  the  microbes  as  well  as  their 
habitat,  and  of  preventing  those  not  destroyed  from 
spreading  amongst  human  beings,  with  nervous  break- 
down the  matter  is  more  complicated  from  the  fact  that 
we  have  neither  a  definite  disease  nor  a  specific  bacillus 
causing  it.  Indeed,  we  have  an  entirely  different  set  of 
circumstances,  for,  as  our  study  of  the  origin  and  mani- 
festation of  the  psycho-neuroses  has  shown  us,  we  have 
in  them  to  deal  with  disorder  affecting  an  association 
of  delicate  nerve -structures  with  over-sensitive  mental 
make-up.  Moreover,  as  a  weakness  of  brain  cells  and  a 
tendency  to  mental  discord  can  actually  become  an 
inherent  family  failing,  the  quickest  way  of  strengthening 
national  nerve  is  to  be  found  not  in  rooting  out  some 
morbid  fungus,  but  in  building  up  the  weakly  on  the  one 
hand,  and  on  the  other,  in  strengthening  impoverished 

173 


174  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

stocks  by  the  infusion  of  fresh  vitality  wherever  possible. 
The  latter  is  an  object  that  can  only  be  secured  when 
heart  and  head  agree  as  to  the  desirability  of  an  alliance 
between  a  man  and  a  woman.  Certainly  it  does  seem  that 
Nature  herself  attempts  this  feat  of  strengthening  stock 
often  enough  when  she  brings  about  a  mysterious  affinity 
between  two  young  people  whose  friends  cannot  make 
out  what  they  "see  in  each  other."  Not  always  do 
"  affinities  "  make  for  health  and  happiness,  but,  as  we 
have  noted  once  before,  the  heart  has  many  reasons  that 
reason  never  knows,  and  sometimes  it  seems  as  if  heart 
instinctively  pointed  in  the  right  direction  for  the  better- 
ment of  a  family  stock  when  the  head  has  been  unable  to 
see  the  way  so  quickly.  A  satisfactory  solution  of  our 
problem  lies  then  in  taking  the  requisite  means  to  reduce, 
generation  by  generation,  racial  Hability  to  nervous  and 
mental  unfitness.  The  goal  is  one  worthy  of  much  striving 
and  special  State  help  to  reach  it.  Certain  it  is  that 
every  nation  that  deliberately  sets  out  to  conserve  and 
improve  the  nerve  energies — and  therefore  the  nerve — of 
its  sons  and  daughters  is  going  to  score  in  a  thousand 
ways  over  those  that  neglect  this  question.  Ca,re  of  body 
and  hygiene  of  mind  are  the  twin  foundation-stones  of 
that  department  of  nerve,  which,  however  described, 
must  be  an  important  element  in  the  looked-for  Ministry 
of  Health.  Priest  and  physician  ;  pa.rent  and  school- 
master ;  press  and  people,  are  all  closely  concerned 
with  its  success.  As  we  have  seen,  it  is  the  strain 
of  mind,  the  waves  of  anger,  fear,  the  storms  of  passion 
as  weU  as  the  insidious  cankers  of  doubt,  jealousy,  envy 
and  their  feUow  sprites  that  swing  over  the  scales  from 
nerve-health  to  neurosis  ;  whilst  a  delicate  physical 
basis  handicaps  the  nervous  system  in  resisting  the 
effects  of  these  storms  and  bHghts. 

Restoration  of  health  from  nervous  breakdown  is 
an  aSair  of  both  mind  and  matter,  physical  measures, 
indeed,  being  directly  related  to  certain  definite  physical 


REDRESSING  THE  BALANCE  175 

needs,  but  our  difficulty  in  restoring  peace  to  the 
troubled  system  is  not  found  so  much  in  regard  to 
securing  greater  strength  of  nerve-cells  as  in  comforting 
the  tortured  soul  and  banishing  the  morbid  thought. 
How  best  we  can  overcome  the  combined  disability 
of  body  and  mind  and  so  redress  the  balance  may 
well  be  our  next  consideration.  At  the  outset  it 
should  be  recognized  that  the  modern  requirements 
of  treatment  in  nervous  disorders  make  exceptionally 
difficult  the  task  of  a  doctor  called  in  to  deal  with 
them.  In  the  first  place,  he  frequently  finds  himself 
handicapped  by  want  of  equipment  and  time  to  deal  with 
the  illness  as  he  would  Uke  to.  Thus  on  the  physical 
side  alone  the  modern  treatment  of  nervous  disorders 
often  demands  special  apparatus — chiefly  electrical — 
a,nd  what  is  more  difficult  to  obtain,  experience  in  using 
it  ;  whilst,  again,  from  the  mental  point  of  view  the 
practitioner  is  often  handicapped  through  want  of  facili- 
ties for  becoming  acquainted  with  psychological  methods. 
It  is  owing  to  this  that  attempts  are  often  made  to  carry 
the  patient  through  with  drugs.  However,  with  an  ill- 
ness which  exhibits  so  surprising  a  range  of  symptoms 
tbe  doctor  finds  it  no  easy  task  to  select  suitable  prepara- 
tions out  of  our  voluminous  pharmacopoeia.  Often 
enough  the  attempt  to  cure  nervous  breakdown  by  drugs 
results  in  something  like  a  return  to  the  medical  blunder- 
bus  of  our  ancestors,  although  the  mixtures  of  to-day 
no  longer  contain  powdered  stones,  crushed  toads,  dried 
blood,  curious  herbs,  and  other  extraordinary  things 
such  as  were  once  poured  down  patients'  throats.  A 
prescription  of  proved  efficacy  for  the  relief  of  particu- 
larly urgent  symptoms  is  justifiable,  but  it  is  a  thousand 
pities  that  a  medical  man  should  ever  waste  energy  on  the 
compounding  of  comphcated  concoctions  for  a  "shot  in 
the  dark,"  when  all  the  time  he  has  within  his  own 
personality  means  more  helpful  in  treating  nervous 
maladies  than  all  the  chemicals  m  the  druggist's  store. 


176     THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

It  is  true  that  inasmuch  as  the  nervous  system  is  in  a 
highly  sensitive  condition  the  sedative  effects  of  bromide 
are  frequently  very  useful  in  lessening  some  of  the  most 
disturbing  symptoms  and   sensations  during  such  time 
as  the  sufferer  is  able  to  make  a  start  on  the  road  to 
recovery.    But  bromides  are  by  no  means  to  be  regarded 
as    curative.     So-called    "  nerve    tonics "    are    for    the 
most  part  a  snare  and  a  delusion  ;    phosphorus,  strych- 
nine, valerian,  arsenic,  and  many  another  find  advocates 
who  extol  their  wonderful  capacities  for  strengthening 
the  nervous  system  ;  but  no  proof  has  ever  been  adduced 
that  these  things  have  any  specific. action  in  nervous  and 
mental  disabihties.    It  is  related  that  a  child  once  wisely 
asked  how  can  one  put  medicine  on  a  thought  !     The 
truth  of  the  ma.tter  is  that  anything  that  will  improve 
general  health  reacts  favourably  on  the  nervous  system. 
Iron  and  arsenic  ;    quinine,  phosphorus  and  strychnine  ; 
as  weU  as  many  another  medicament  have  general  tonic 
properties,  and  therefore  can  often  be  made  to  play  a  part 
when  one  frames  a  general  attack  upon  neurasthenia. 
To  rely  on  either,  or  aU,  as  "  cures  "  is  to  rely  on  a  broken 
reed.     Occasionally  one  of  the  common  tonics  will  aet 
with  almost  magical  efficacy  in  improving  health  in  a 
few  individual  cases.    Where  this  is  so  let  every  advan- 
tage be  taken  of  the  happy  fact.     Certainly  of  all  tonic 
remedies  iron  is  the  most  reliable  ;   whilst  improving  the 
blood,  it  helps  to  restore  the  nerve  system  to  a  healthier 
state.    Still,  there  yet  remains  to  be  discovered  an  elixir 
that  will  restore  the  tissues  of  the  flagging  brain,  and 
build  up  those  minute  corpuscles — ^the  so-called  "  Nissl's 
granules" — normally  present  within  healthy  nerve-cells, 
which    have    been    found    to    break    up    or    disappear 
coincidentaUy  with  profound  exhaustion. 

It  is  well  that  these  things  should  be  understood,  for 
one  finds  numbers  of  neurasthenic  people  persistently 
taking  "  nerve  tonics,"  hoping  against  hope  that 
sooner  or  later  permanent  benefit  wiU  be  derived  from 


REDRESSING  THE  BALANCE  177 

them.  Let  them  look  upon  sedatives  and  nerve  tonics  as 
useful  temporary  remedies,  helpful  in  tiding  over  a  diffi- 
cult passage,  but  by  no  means  able  to  get  at  the  root  of 
their  troubles,  then  they  will  be  in  a  far  better  position  to 
carry  out  a  successful  offensive  against  their  illness. 
People  who  rely  too  much  on  medicines  find  the  day  comes 
when  the  sickness  borne  of  deferred  hope  further  adds  to 
their  load.  They  begin  to  think  their  plight  hopeless,  to 
believe  that  health  is  irretrievably  lost  ;  energy  gone  for 
ever,  and  mental  comfort  no  longer  possible  ;  this  is 
to  initiate  a  process  of  morbid  self-suggestion  leading 
directly  to  that  state  of  chronic  invalidism  which  is  the 
sad  lot  of  many  who,  properly  piloted,  might  long  ago 
have  reached  a  haven  of  health. 

There  are  many  ways  in  which  physical  means  can 
be  used  for  the  assistance  of  some  neurasthenics,  and 
often  of  nervous  people  suffering  from  serious  but 
ill-defined  states  threatening  their  mental  well-being. 
But  for  the  majority  of  functional  conditions  treatment 
through  mind  is  everything,  and  time  after  time  when 
one  comes  to  analyse  an  alleged  cure  through  matter  it 
is  found  that  "  suggestion  "  has  been  strongly  at  work 
through  the  very  physical  medium  which  is  being  ex- 
tolled. Particularly  is  this  the  case  when  hysteria  yields 
to  electricity.  The  comparative  results  lately  obtained 
by  various  workers  in  the  military  hospitals  show  that 
with  the  right  mental  attitude  on  the  part  of  the  doctor 
the  cure  of  many  war-neuroses  can  be  just  as  quickly 
brought  about  through  mind  alone  as  through  mind  plus 
some  material  infiuence  brought  in  as  a  persuasive  instru- 
ment. If  we  honestly  believe  that  a  mind  cure  is  indi- 
cated then  let  us  decide  to  carry  it  out  honestly,  and  not 
shirk  the  main  issue  or  trick  the  sufferer  by  saying  that 
electricity,  massage  or  a  lotion  is  the  curative  agent. 
So  to  do  is  really  only  curing  one  false  conception  by 
another. 

To  review  the  physical  measures  that  can  be  used  to 


178  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

assist  recovery  in  the  psycho-neuroses  would  be  to  con- 
sider the  whole  range  of  modern  medical  and  surgical 
procedures.  Drugs,  operations,  injections,  vaccines — 
all  these  things  find  a  useful  place  at  one  time  and  another. 
The  point  being  that  anything  that  will  improve  physical 
health  in  general  wiU  help  recovery  ;  particularly  when 
in  neurasthenia  physical  disabilities  figure  prominently. 
But  there  is  no  specific  drug,  injection,  vaccine,  or  opera- 
tion that  will  certainly  help  the  neurasthenic  or  the 
hysteric.  On  the  other  hand,  there  are  two  modes  of 
physical  treatment  more  constantly  helpful  than  any 
others  in  restoring  nerve-tone  and  reinvigorating  an 
exhausted  nervous  system  from  the  material  side.  One 
is  electricity  ;  the  other  is  massage,  which  wiU  be  referred 
to  again  when  considering  the  "  rest-cure,"  in  the  routine 
of  which  it  finds  its  most  useful  place. 

Electricity  is  the  agent  which  in  our  experience  most 
closely  8.pproaches  our  conception  of  life-force  itself. 
Invisible  and  intangible,  known  only  by  its  results,  and 
demonstrable  solely  by  the  wonderful  things  it  does, 
electricity  seems  the  main-spring  of  aU  hving  processes, 
and,  moreover,  according  to  modern  investigations  is 
possibly  the  foundation  of  matter  itself.  This  is  no  place 
for  speculation  on  the  fascinating  problems  of  electricity  ; 
let  it  suffice  to  say  that  it  has  been  shown  to  have 
very  close  relations  with  everything  that  goes  on  in  the 
human  body,  and  is  to-da,y  considered  by  various  able 
investigators  to  have  close  affinities  with  that  equally 
subtle  influence  which  we  speak  of  as  nerve-force  or 
nerve-energy.  Living  tissues  in  all  directions  have  been 
shown  particularly  susceptible  to  this  influence,  being 
strengthened  under  some  conditions  and  weakened 
under  others.  Under  the  influence  of  electrified  atmo- 
spheres plants  have  been  shown  to  grow  with  greater 
vigour,  whilst  their  seeds  have  under  the  same  exposure 
developed  exceptional  vitality.  Again,  sensitive  galvano- 
meters attest  the  currents  generated  in  human  organs 


REDRESSING  THE  BALANCE  179 

during  their  activities.  Thus  it  is  accepted  to-day  as  quite 
certain  that  action  of  brain-cells  and  nerve -cells  generally 
is  accompanied  by  electrical  disturbances. 

Hence,  it  is  not  surprising  that  amongst  physical 
means  helpful  in  the  treatment  of  neurasthenic  and 
other  nervous  states  electricity  must  be  highly  esteemed. 
In  its  range  of  possibilities  and  general  effects  the  electri- 
cal current  opens  numerous  roads  through  which  we  can 
pour  fresh  energy  into  the  devitahzed  nervous  system  ; 
whilst  at  the  same  time  it  enables  us  to  soothe  or  stimu- 
late special  areas  with  ease.  In  spite  of  this,  however, 
the  uses  of  electricity  in  the  treatment  of  nervous  mala- 
dies remain  much  misunderstood.  It  is  by  no  means 
uncommon  to  hear  people  seeking  help  say  "  We 
have  tried  electricity  "  ;  nor  is  it  rare  to  hear  from 
doctors  that  they  have  failed  to  give  help  by  electrical 
methods.  Electricity  is  no  panacea  in  neurasthenia,  but 
is,  nevertheless,  very  helpful  in  treatment.  Success  in  the 
use  of  electricity  can  only  come  through  a  grasp  of  the  wide 
scope  of  its  employment  ;  misconception  of  the  prin- 
ciples on  which  its  use  in  nervous  disorders  should  be 
based  leads  to  a  foolish  and  unscientific  handling  of 
apparatus.  Curiously  enough,  one  sometimes  finds 
ignorant  exercise  of  electrical  methods  by  some  who 
think  this  a  legitimate  method  of  mental  treatment  ; 
their  intention  being  to  convey  a  suggestion  of  some- 
thing being  done,  and  so  to  produce  a  health-giving 
impression.  Such  methods  offend  against  a  funda- 
mental rule,  for  mental  treatment  should  be  based  on 
truth  and  not  on  falsehood,  and  the  less  false  sugges- 
iiions  are  reHed  upon  to  help  one's  feUows  the  better  for 
all  concerned. 

Electrical  applications  to  be  helpful  should  be  pre- 
scribed with  due  regard  to  several  important  points, 
including  particularly  the  special  form  to  be  used,  the 
quantity  to  be  given,  and  the  length  of  time  for  which 
the  treatment  is  to  continue.    There  are  other  considera- 


180  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

tions,  such  as  the  number  of  treatments  to  be  given  a 
week,  the  hour  of  their  administration,  and  the  relation 
that  electricity  is  to  bear  to  the  rest  of  the  remedial 
campaign.  Scientific  apparatus  gives  ample  means  of 
measuring  the  dosage  in  those  forms  where  accurate 
measurement  is  essential,  whilst  experience  of  one's 
instruments  enables  one  to  make  a  suitable  calcula- 
tion where  instrumental  estimation  is  not  available. 
Scientific  use  of  electrical  methods  has  been  greatly 
developed  by  war-time  requirements,  and  many  doctors 
who  have  had  experience  of  work  with  the  Army  will 
take  back  into  private  practice  a  much  greater  apprecia- 
tion of  this  powerful  agent  for  treatment  than  they 
would  otherwise  have  achieved.  Detailed  discussion  of 
the  merits  and  technique  of  the  different  ways  of  ad- 
ministering electricity  is  beyond  the  scope  of  this  book, 
but  a  general  knowledge  of  the  chief  principles  to  be 
observed  in  its  administration  is  nowadays  of  public 
importance.  It  is  highly  desirable  that  people  should  be 
able  to  protect  themselves  from  the  false  claims  and 
dangerous  service  of  ignorant  pretenders.  Holes  burnt 
in  a  man's  arm  by  the  careless  handling  of  a  well-meaning 
individual  who  thought  he  knew  "  all  about  electricity," 
for  example,  help  to  convince  one  that  the  medical  pro- 
fession has  a  duty  to  perform  in  educating  the  public  as 
to  the  potentialities  and  common  use  of  electricity  in 
healing.  Such  an  instance  of  misguided  zeal  and  ignorant 
technique  comes  to  mind. 

It  is  to  be  noted  that  one  meets  with  the  greatest 
divergency  of  opinion  about  electricity  as  a  remedy  for 
nervous  disorders.  Some  neurologists  appear  to  pass 
through  three  phases  of  experience.  At  first  sceptical, 
they  subsequently  become  impressed  by  electro-thera- 
peutic results  and  for  a  period  place  considerable  rehance 
on  electrical  methods.  Finally,  they  come  to  realize  how 
difficult  it  is  to  estimate  how  much  of  the  benefit  is 
obtained  from  the  current  itself  and  how  much  is  reaUy 


REDRESSING  THE  BALANCE 

due  to  the  psychological  influence  of  those  carrying  out 
the  treatment.  My  own  view  is  that  electricity  is  an 
extremely  useful  secondary  agent,  having  both  tonic 
and  sedative  properties  according  to  the  method  of 
application,  but  that  its  accomplishments  are  poor 
where  the  psychological  factor  is  neglected. 

Medicines,  electricity,  massage,  with,  of  course,  rest 
and  good  food,  offer  ample  means  of  building  up  a 
depleted  nervous  system.  But  success  in  treatment 
depends  on  the  fulfilment  of  three  other  conditions  also. 
These  are  that  physical  drains  and  strains  shall  be 
checked  ;  that  stresses  acting  through  the  feeUngs  shall 
be  ehminated  ;  that  a  general  adjustment  of  thought 
and  mental  outlook  shaU  take  place.  Just  as  assisting 
from  the  physical  side  means  making  use  of  the  routine 
measures  of  medical  practice,  as  already  noted,  so  the 
checking  of  physical  disorders  bearing  hardly  on  the 
brain  and  other  nerve-centres  belongs  to  the  daily  pro- 
gramme of  the  family  doctor.  In  so  far  as  it  is  desirable 
to  discuss  this  side  of  the  question  in  the  present  volume 
these  matters  wiU  be  referred  to  when  dealing  with  the 
•"  rest-cure  "  where  they  have  not  already  been  touched 
upon.  It  is  the  psychological  task  to  be  accomplished 
in  restoring  harmony  to  a  shaken  system  that  offers  the 
most  difficulties,  and  is  withal  the  essential  part  of  the 
plan  of  treatment  in  most  instances.  Always  in  ill- 
health  the  individual  is  to  be  considered  as  well  as  his 
malady  ;  in  a  nervous  breakdown  the  individual  com- 
monly requires  more  attention  than  his  illness.  William 
James  used  to  discuss  at  length  and  in  his  own  enchanting 
way,  the  psychology  of  the  "  sick  soul."  It  is  a  fact  that 
the  victims  of  nervous  breakdown  are,  either  tempera- 
mentally or  for  the  time  being,  sick  souls.  They  see 
things  through  a  glass  darkly,  A  fog  of  jaundiced  thought 
seems  to  come  between  them  and  happiness  of  outlook. 
Of  two  things  one  ;  and  that  the  negative  for  the 
neurasthenic    as    a    rule,   and    for   the    hysteric    often. 


182  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

The  surest  foundation  of  mental  health  is  faith  in 
things  unseen — ^the  sense  that  God  is  in  His  Heaven 
and  all's  right  with  the  world  no  matter  what  appear- 
ances may  be.  Most  emphatically  it  is  this  sense  of  the 
essential  "  all-rightness  "  of  things  that  the  neuras- 
thenic lacks.  Many  are  like  this  from  earliest  years. 
To  attain  health  of  mind  means  for  them  nothing  less 
than  a  new  birth  ;  these  are  they  to  whom  "  conversion  " 
or  sudden  realization  of  things  spiritual  brings  with  it  a 
new  lease  of  life  in  which  for  the  first  time  happiness  is 
genuinely  present.  Others  fail  in  later  life,  losing  the 
optimism  and  mental  comfort  they  have  hitherto  known. 
Born  into  the  grace  of  health  they  forfeit  their  birth- 
right, sometimes  sacrificing  it  to  pagan  gods. 

The  inherently  sick  in  soul  are  those  of  the  morbid 
nervous  temperament.  As  we  have  seen,  nervousness, 
as  a  temperamental  characteristic  may  serve  to  liven  up 
an  otherwise  dull  person  ;  it  may  add  zest  and  sparkle 
to  life  ;  it  may,  indeed,  supply  just  that  element  which 
makes  for  fame  and  fortune  in  many  walks  of  fife.  To 
be  nervous  is  not  necessarily  to  be  morbid,  but  it  is  true 
that  in  many  the  nervous  temperament  has  an  unhealthy 
tendency,  and  it  is  these  who  are  the  confirmed  worriers, 
wrong- thinkers,  and  anxiety-mongers.  They  constitute 
the  bulk  of  the  sufferers  from  constitutional  nervous 
instability.  With  vision  turned  in  upon  themselves  they 
habitually  contract  their  whole  lives  until  within  the 
limits  of  an  ever-narrowing  morbid  circle  they  eke  out 
their  fear-fraught  lives.  For  such,  indeed,  health  of 
mind  and  nerve  can  come  only  through  a  great  psychologi- 
cal upheaval — "  conversion  " — as  a  result  of  which 
locks  are  broken,  bars  are  sundered  and  the  whole 
machinery  of  life  and  thought  is  allowed  to  run  free. 
Then  with  quickening  pulses  and  rising  health  the  erst- 
while prisoner  looks  out  on  to  the  world  which  he  sees 
with  normal  vision  perhaps  for  the  first  time  for  many 
years — perhaps  for  the  first  time  in  his  life.      To  gain 


REDRESSING  THE  BALANCE  183 

an  understanding  of  life,  to  get  feet  firmly  planted  on 
some  sound  rock  of  religion  or  philosopliy  is  the  essen- 
tial condition  of  such  a  change.  Sometimes  coming  from 
within — or  seemingly  as  a  spiritual  message — commonly 
the  process  is  initiated  by  the  "  suggestion  "  of  some  new 
and  bond-breaking  idea  conveyed  by  book,  sermon  or 
talk  with  a  friend.  In  these  days  such  ideas  are  now 
quite  often  utilised  deliberately  as  a  form  of  treatment. 
Sometimes  they  are  suggested  forcibly  and  with  a  take- 
no-denial  manner  ;  sometimes  based  on  reason  ;  some- 
times to  assist  analysis  of  the  morbid  idea  until  it 
is  proved  false  ;  occasionally  on  rehgious  observance. 
And  so  we  have  the  methods  of  suggestion,  hypnotism, 
persuasion  and  psycho-analysis  used  so  commonly  to- 
day by  medico -psychologists,  corresponding  to  the  first 
three  of  these  forms  of  attack.  Lastly,  we  have  the 
increasing  attempts  to  find  a  medium  for  the  healing 
powers  of  spirit,  and  to  uplift  suffering  humanity  towards 
the  source  of  all  life,  health,  and  power  so  that  our  iUs 
must -be  dispelled  like  mist  before  the  sun's  rays.  The 
merit  of  this  mind-heaHng  carried  to  its  highest  possible 
terms  is,  of  course,  that  it  seeks  not  merely  to  remove  ills 
and  discomforts  of  nerves  and  body,  but  to  uplift  physi- 
cally and  spiritually  the  whole  individual. 

As  worry,  grief,  anxiety,  fear  and  mental  shock  play 
so  conspicuous  a  part  in  weakening  our  "  nerves  "  it 
follows  that  if  one  can  obtain  the  confidence  of  the 
sufferer  and  by  judicious  and  tactful  conversation  sug- 
gest ideas  which  will  enable  him  to  overcome  his  morbid 
thoughts  and  feelings  one  can  thus  remove  causes  operat- 
ing from  the  mental  side.  Moreover,  from  the  admitted 
proof  of  this  the  further  conclusion  is  derived  that  wher- 
ever a  mental  cause  for  ill-health  can  be  diagnosed  the 
rational  method  of  attack  must  always  be  through  mind. 
As  the  operation  of  psychological  factors  is  most  clearly 
seen,  and  has  been  most  closely  studied,  in  nervous 
disorders,  mitid-cure  must  occupy  a  prominent  place  in 


184  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

any  discussion  of  the  problem  of  nervous  breakdown.  In 
no  other  form  of  illness  is  it  so  urgent  that  we — 

.   .  .  minister  to  a  mind  diseased, 
Pluck  from  the  memory  a  rooted  sorrow, 
Raze  out  the  written  troubles  of  the  brain. 
And  with  some  sweet  oblivious  antidote 
Cleanse  the  stuff'd  bosom  of  that  perilous  stuff 
Which  weighs  upon  the  heart  !  ^ 

Indeed,  so  closely  is  the  scientijfic  study  and  appHcation 
of  treatment  through  mind  bound  up  with  the  relief  of 
mental  and  nervous  troubles  that  it  is  quite  customary 
to-day  to  make  the  success  of  such  treatment  diagnostic 
of  the  Idnd  of  malady  remedied.  A  remarkably  sharp 
line  is  thus  quite  arbitrarily  drawn  between  the  "  func- 
tional "  ailments  held  to  be  curable  by  mental  thera- 
peutics and  the  "  organic  "  diseases  supposed  to  be 
beyond  reach  of  mind.  When  it  is  related  that  someone 
suffering  from  an  incapacitating  illness  of  some  years' 
duration  has  suddenly  recovered  after  prayer,  suggestion 
or  other  means  working  in  thought,  medical  orthodoxy 
at  once  welcomes  the  recovery,  but  says  "  Oh  !  So-and- 
so's  troubles  were  '  functional  '  (or  nervous)  after  all  !  " 
Moreover,  in  some  cases  of  impaired  strength  or  sensa- 
tion the  effect  of  "  suggestion  "  is  not  infrequently 
relied  on  to  indicate  the  extent  of  the  damage  in  brain 
or  spinal  cord.  If  improvement  occurs  the  diagnosis  of 
"  functional  "  is  finally  made,  otherwise  the  case-sheet 
is  marked  "  organic."  This  is  without  doubt  an  unscien- 
tific way  of  looking  at  the  question.  The  admitted  dis- 
tinction between  "  functional  "  (nervous)  and  "  organic  " 
troubles  is  that  in  the  latter  structural  damage  is  demon- 
strable, and  in  the  former  unrecognizable  even  by  the 
microscope.  Improved  methods  of  microscopic  examina- 
tion are  continually  revealing  fine  structural  changes 
previously  unknown  in  obscure  diseases,  and  it  is  not  an 
unreasonable  supposition  that  such  modes  of  investiga- 

1  Macbeth,  Act  V,  So.  3. 


REDRESSING  THE  BALANCE  185 

tion  will  probably  demonstrate  similar  departures  from 
healthy  state  of  the  tissues  in  most  or  all  maladies. 
Judging  from  the  recent  results  of  microscopic  inquiry 
one  may  suppose  that  every  condition  of  illness, 
"  functional  "  or  "  organic  " — ^including  nervous  break- 
down in  all  its  varied  forms — is  accompanied  i^by 
abnormal  states  of  nerve-cells  and  nerve  fibres  in  the 
brain  or  elsewhere.  This  is,  of  course,  the  position  of  the 
materialistic  school  as  to  the  physical  bases  of  disease, 
and  one  may  readily  admit  it.  And  to  do  so  really  widens 
rather  than  narrows  the  possible  scope  of  treatment 
through  mind  from  the  scientific  point  of  view.  Assum- 
ing that  neurasthenia,  hysteria,  and  other  functional 
disorders  are  associated  with  structural  damage — some 
injury  in  the  tiny  cells  of  the  brain  or  other  nerve-centres 
let  us  suppose — ^then,  in  the  light  of  admitted  successes 
of  mind  treatment,  does  not  this  very  circumstance  prove 
that  thought,  "  suggestion,"  ideas  can  and  do  actually 
react  on  the  tissues  of  the  nervous  system  ?  And  if 
directly  on  the  nervous  system,  why  not  directly  or 
indirectly  on  other  organs  ?  Even  now  we  have  cases 
where  the  disorder  is  such  that  it  is  difficult  enough  to 
say  whether  the  trouble  is  due  to  disseminated  patches 
of  degeneration  in  the  spinal  cord — a  definite  enough 
"  organic  "  condition  if  present — or  whether  it  is  due  to 
hysteria — ^the  very  type  of  a  purely  "  functional  "  ail- 
ment. To  say  that  if  in  such  a  case  cure  follows  "  sug- 
gestion "  it  must  be  the  latter,  and  if  not  the  former,  is 
an  unsound  method  of  reasoning. 

The  quest  for  a  reliable  principle  of  mental  heaKng 
has  been  persistently  pursued  for  at  least  three  thousand 
years,  and  probably  from  much  earlier  days  of  human 
endeavour.  At  all  times  mankind  seems  to  have  ex- 
hibited two  intellectual  types  ;  one  tending  to  a  material- 
istic outlook,  and  the  other  to  a  spiritual  view  of  things 
as  they  are.  It  is  the  latter  who  have  maintained  the 
active  pursuit  of  our  finest  powers  and  whose  burning 


186  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

enthusiasm  has  kept  alight  the  fires  of  faith  in  the 
spirit  and  its  works,  even  during  the  darkest  ages 
of  thought.  With  regard  to  the  problem  of  treatment 
it  appears  that  at  no  time  during  recorded  history  was 
loiowledge  of  healing  through  mind  ever  entirely  lost  ; 
on  the  contrary,  there  are  many  records  of  its  practice 
under  various  forms  in  many  countries.  There  were 
healing  rites  in  ancient  Egypt  ;  and  in  the  great  days 
of  Greece  sumptuous  temples  of  healing  received  count- 
less thousands  of  the  sick  who  rested  under  the  supposed 
influence  of  the  gods  until  restored  in  health.  The 
prophet  healers  of  Israel  had  no  doubt  of  the  powers  of 
spirit  in  this  direction.  The  Bible  is,  indeed,  a  wonderful 
chronicle  of  miracles  of  healing.  And  it  is  interesting 
to  note  that  from  the  most  ancient  times  down  to  the 
present  day  there  has  been  a  tendency  for  the  methods 
used  to  evolve  from  the  grossest  rites  of  superstition  to 
an  increasing  realization  of  spiritual  power  as  an  expres- 
sion of  a  divine  principle  of  love.  At  first  centred 
round  the  invocation  of  helpful  gods  to  exorcise  and 
destroy  evil  demons,  a  process  assisted  by  an  elaborate 
ceremonial  ;  later  regarded  as  the  flowing  out  of  a  healing 
fluid  from  one  to  another,  particularly  under  the  blessing 
of  a  beneficent  deity  ;  ultimately  conceived  as  the  work- 
ings of  pure  spirit  in  matter,  this  evolutionary  process 
has  left  its  traces  in  various  practices  of  healing  to-day. 
For  those  who  have  followed  the  upward  path  super- 
stition has  given  way  to  sublime  faith  ;  magic  has  yielded 
to  mysticism.  The  seal  was  set  on  this  understanding 
of  spiritual  power  when  in  his  healings  Jesus  rebuked  the 
superstitious  "  casters  out  of  devils,"  and  showed  that 
all  healing  is  really  of  God  and  that  in  healing  as  in  aU 
else  we  have  not  to  rely  on  magical  placations  of  evil 
spirits,  but  on  faith  in  that  God  who  is  Spirit,  and  is  Love. 
Thus  it  is  to-day  that  the  study  of  treatment  through 
mind  must  embrace  a  wide  range  of  practices,  and  in 
regard  to  its  special  application  to  the  alleviation  of 


REDRESSING  THE  BALANCE  187 

nervous  disorders  must  not  only  take  into  account  the 
suggestive  therapeutics,  the  medical  hypnotism,  and 
the  psycho-analyses  of  orthodox  psychology,  but  go 
farther  and  attempt  to  understand  how  and  on  what 
basis  prayer  and  appeals  to  the  highest  spiritual  instincts 
of  mankind  have  curative  value. 


CHAPTER  II 

THE    REST  CURE 

{A)  General  Principles 

Natiiral  recuperative  forces  —  The  great  vis  medicatrix  naturae — 
Medieval  evil  and  modern  medicine  contrasted — The  principle  of 
rest— Weir  Mitchell's  rest-cure — Modem  modifications — Planning 
a  rest  cure — Attitude  of  invalid — Duration — Place  of  treatraent — 
Home  or  institution — Nursing — Qualifications  of  the  nerve  nurse — 
General  surroundings. 

THE  knowledge  that  there  are  forces  within  us  con- 
stantly striving  to  renew  worn-out  tissues,  to  build  up 
broken  down  organs,  to  combat  germs  and  to  restore  lost 
nerve-energy,  is  a  paramount  influence  in  all  branches 
of  treatment  to-day.  It  is  one  of  the  great  concepts  of 
modern  science.  In  old  times  an  invalid's  main  support 
was  found  in  a  pill,  plaster,  or  potion.  Surgical  operation 
was  a  thing  of  horror  only  to  be  faced  under  circumstances 
of  extreme  need.  lUnesses  were  considered  to  be  of 
various  specific  kinds,  curable  only  when  the  correspond- 
ing specific  remedy  could  be  exhibited.  An  important 
part  of  the  medical  student's  education  was  understood 
to  be  the  steady  pursuit  of  specific  antidotes  ;  and 
people  had  little  doubt  that  one  doctor  was  more  skilled 
than  another  because  his  memory  contained  a  longer  list 
of  suitable  cures.  The  idea  that  Nature  is  always  doing 
her  best  to  help  a  sick  person,  and  that  the  doctor  could 
do  some  of  his  best  work  by  assisting  Nature,  at  last  came 
to  irradiate  many  dark  places.  Certainly  the  great  truth 
had  been  dimly  perceived  during  the  ages  by  a  few 
masters  of  medicine.     Thus  several  hundred  years  ago 

188 


THE  REST  CURE  189 

the  great  French  surgeon,  Ambrois  Pare,  exclaimed  on 
a  stricken  battlefield,  "  I  dress  the  sufferer  ;  God  heals 
him,"  a  sentiment  that  cuiiously  enough  was,  cen- 
turies later,  expressed  in  keen-edged  irony  by  another 
great  Frenchman,  MoHere,  who  remarked  that  the 
physician  amused  the  invalid  whilst  God  healed  him. 
But  it  was  long  before  this  great  truth  became  plain  to  the 
majority.  Nowadays  recognition  of  the  great  natural 
heahng  forces  working  in  each  one  of  us — ^the  great  vis 
medicatrix  naturae — points  the  way  for  us  ;  we  now  know 
that  much  of  the  doctor's  work  should  be  strenuous  endea- 
vour to  remove  obstructions  to  Natm-e's  healing  balm. 
In  many  illnesses  the  physician,  who  not  so  very  many 
years  ago  would  have  put  his  patient  through  a  terrible 
ordeal  of  drugs,  blisters  and  bleeding,  is  now  content  to 
pursue  what  has  been  called  a  policy  of  masterly  in- 
activity. He  watches  beside  the  sick  man's  bed,  waiting 
for  an  opportunity  to  guide  the  inherent  life-forces  ; 
to  assist  a  flagging  organ  here,  to  relieve  a  tired  system 
there  ;  using  his  drugs  as  useful  aids  in  his  work  and  not 
placing  sole  reliance  upon  them  as  infallible  remedies. 
When  breakdown  threatens  any  part  of  the  human 
machine  the  best  way  to  give  Nature  an  opportunity  of 
exercising  her  wonderful  powers  to  the  utmost  is  by 
taking  some  of  the  load  of  daily  work  off  the  strained 
chains  and  cogs.  In  a  word,  rest  of  overburdened  organs 
must  be  a  leading  principle  of  treatment. 

When  one  has  to  deal  with  an  organism  so  closely 
bound  up  with  the  activities  of  the  body  as  the  nervous 
system,  the  appHcation  of  rest  necessarily  includes  a  pro- 
gramme of  diminished  work  for  both  body  and  mind  ; 
and  it  has  been  the  recognition  of  this  that  has  led  to  the 
advocacy  of  the  "  rest-cure  "  as  a  means  of  restoring 
health  in  nervous  debility.  As  originally  carried  out 
under  the  auspices  of  its  most  celebrated  exponent,  the 
late  Dr.  Weir  Mitchell,  an  American  savant,  the  rest-cure 
was  chiefly  intended  to  enable  the  body  to  make  physical 


190  THE  PROBLEM  OF  XERVOUS  BREAKDOWN 

leeway.  NeuraBtlieiiia.  for  example,  was  regarded 
primarily  as  an  exhaustion  of  nervous  tissues,  and  an 
endeaTour  made  to  restore  from  the  physical  side  the 
lost  energies,  to  rest  the  body  by  committing  it  to  bed  for 
a  long  time,  to  reduce  brain  activity  to  a  minimum  by 
shutting  off  all  business  and  private  worries  :  to  get  rid 
of  even  the  little  strain  put  on  the  nerves  by  letters  from 
or  intercourse  with,  friends  :  and  to  build  up  the  physical 
system  by  supplying  it  to  repletion  with  rich,  digestible 
food — such  were  the  essential  principles  of  what  has  come 
to  be  known  as  the  Weir  Mtchell  treatment.  In  this 
regime  the  disadvantages  of  too  much  bodily  inactivity 
were  fully  recognized,  and  massage  was  ordered  as  a  means 
of  keeping  the  muscles  of  the  body  and  Hmbs  in  a  state  of 
proper  tonicity.  It  was  realized  that  when  people  lie 
in  bed  their  muscles  become  flabby,  whilst  the  want  of 
movement  favoured  sluggishness  of  the  circulation.  The 
invalid  was  massaored  dailv  to  obviate  these  disadvantages. 
The  full  Weir  ]\IitcheU  rest-cure  is  by  no  means  as 
popular  to-day  as  it  was  a  few  years  ago.  Under  some 
practitioners  it  always  gives  excellent  results :  by  many 
others  it  has  not  been  found  very  successful.  Where  it 
fails,  failure  is  invariably  due  to  the  one  weak  point  in 
the  method.  The  fact  is  that  the  Weir  Mitchell  rest  cure 
depends  for  its  success  upon  the  degree  to  which  the 
mental  factor  is  taken  into  consideration.  In  the  hands 
of  its  originator  and  his  immediate  disciples,  the  im- 
portance of  support  through  mind  was  fully  recognized  ; 
the  isolation  insisted  upon,  and  the  regular  visits  from 
the  physician  whose  duty  was  understood  to  consist 
partly  of  encouraging  the  invahd,  aU  implied  that  sug- 
gestion and  persuasion  were  to  be  used  as  a  matter  of 
routine.  On  the  other  hand,  those  who  have  merely 
copied  the  mechanical  details  have  never  found  its 
results  as  satisfactory  or  as  lasting  as  those  who  have 
realized  that,  to  be  complete,  Weu'  ]\Iitchell's  methods 
include    psychological    as    well    as   physical    treatment. 


THE  REST  CURE  191 

Where  one  finds  a  practitioner  using  the  plan  with 
constant  success  there  one  as  certainly  finds  a  doctor 
who  reaKzes  that  his  patients  have  souls  as  well  as 
bodies. 

A  rest-cure  to-day  commonly  takes  note  of  the  require- 
ments indicated  above,  but  is  less  strict  in  regard  to 
isolation,  to  the  drinking  of  large  quantities  of  milk,  and 
long  apphcations  of  massage.  Details  vary  a  good  deal 
in  individual  hands,  according  to  the  point  of  view  of  the 
practitioner.  Some  lay  more  stress  on  the  physical  than 
on  the  mental  features  of  the  treatment  ;  whilst  others 
take  the  opposite  view.  Then,  again,  the  part  to  be 
played  by  such  methods  as  electrical  applications,  vac- 
cines and  so  forth,  also  influences  the  routine  in  individual 
cases.  The  most  important  point  to  be  appreciated  is  that 
whilst  there  is  little  difiiculty  about  resting  a  tired  body, 
and  little  trouble  in  feeding  up  an  invalid  so  that  weight 
is  put  on,  it  is  by  no  means  as  easy  to  eradicate  the  de- 
pression and  morbid  thoughts  usually  associated  with 
the  physical  symptoms  in  nervous  breakdown.  Time 
after  time  one  sees  people  who  have  been  through  a  "  suc- 
cessful "  rest-cure,  looking  fat  and  well,  sleeping  properly, 
and  apparently  restored  to  health,  but  who,  nevertheless, 
within  a  short  time  rapidly  lose  weight  and  quickly  sink 
into  the  depths  once  more.  Apart  from  the  fact 
that  there  are  many  active-minded  persons  to  whom  the 
mechanical  routine  of  a  rest-cure  in  which  the  mental 
factor  is  ignored  is  extremely  irritating,  the  omission  of 
measures  intended  to  restore  the  invalid's  confidence  in 
himself  and  to  give  him  a  bright  outlook  is  almost  certain 
to  bring  about  ultima.te  failure.  Let  us  now  study  the 
requirements  of  a  m^odern  rest-cure  designed  to  restore 
the  victim  of  "  nerves  "  to  a  really  satisfactory  state 
of  health. 

When  advice  has  been  given  that  someone  is  to  under- 
go a  rest-cure  three  very  important  things  have  to  be 
settled  at  once.    In  the  first  place,  one  wants  to  know  if 


192  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

the  invalid  is  really  willing  ;  for  it  is  always  unsatisfactory 
to  treat  those  who  are  averse  from  the  particular  method 
of  giving  assistance  that  is  suggested.  All  the  more  so 
when  it  is  a  matter  of  lengthy  and  somewhat  tiresome 
routine  the  hearty  co-operation  of  the  patient  is  all  the 
more  essential  to  success.  Those  who  definitely  protest 
and  only  agree  to  rest  whilst  so  protesting  had  much 
better  be  either  left  to  work  out  their  own  salvation  in 
their  own  way,  or  invited  to  co-operate  on  other 
lines.  Those  who  say,  "  I  am  not  very  hopeful,  and 
don't  think  anything  can  cure  me,"  but  will  willingly 
and  obediently  carry  out  the  programme  advised,  take 
up  a  not  entirely  unreasonable  attitude,  and  are  usually 
found  to  co-operate  more  and  more  heartily  as  time 
goes  on.  The  invalids  who  say,  "We  will  willingly  do 
our  best  to  help  you  to  help  us,"  and  will  look  forward 
and  upward  to  health  and  success,  make  the  best 
patients. 

The  second  thing  to  be  decided  is  the  minimum  length 
of  time  to  be  given  up  to  the  treatment.  Various  circum- 
stances influence  this  decision.  Where  there  is  great 
debility  the  question  has  to  be  decided  solely  on  grounds 
of  the  health  interest  of  the  patient,  but  in  many  less 
severe  cases  interests  and  occupations,  matters  of  ex- 
pense, family  duties,  and  so  forth,  all  have  to  be  con- 
sidered. Unfortunately,  there  is  always  a  risk  that,  in 
trying  to  save  the  invalid  expense,  the  physician  may 
err  in  advising  too  short  a  time  for  the  "  cure,"  which 
then  fails.  People  forget  that  when  their  nervous  systems 
have  been  losing  strength  for  perhaps  two  or  three  years,  it 
is  unreasonable  to  expect  health  and  tone  to  be  restored 
within  a  month  or  six  weeks.  Sometimes  a  great  deal 
can  be  done  within  a  month  ;  more  often  six  weeks  is  a 
minimum  and  three  months  desirable.  It  all  depends  on 
individual  conditions,  but  on  an  average  three  months 
rather  than  one  is  necessary  to  achieve  a  really  happy 
ending  to  the  illness.    Relatives  should  be  careful  not  to 


THE  REST  CURE  i    - 

embarrass  the  doctor  by  an  endeavour  to  persuade  bim 
to  reduce  the  time  he  has  advised,  remembering 
that  if  they  persuade  him  against  his  better  judg- 
ment the  result  will  probably  be  unfortunate  for 
everyone  concerned.  Time  is  a  great  factor  in  the 
treatment  of  all  mental  and  nervous  troubles.  The 
exhausted  brain-cells  require  not  only  rest  to  enable 
natural  recuperative  forces  to  restore  them,  but  time 
for  the  healing  action  to  proceed  in  full,  and  time  for  the 
tormented  mind  to  replace  its  depressing  thoughts  by 
healthy  and  cheerful  ideas.  Moreover,  when  the  task 
has  been  accomplished  a  little  extra  time  enables  the 
good  work  to  be  consolidated  on  a  sound  foundation  of 
mental  health  and  physical  well-being. 

The  third  point  that  has  to  be  discussed  and  decided 
upon  is  place.  Where  is  the  invalid  to  undergo  treatment  ? 
The  choice  of  place  is,  after  all,  limited.  There  is  the 
patient's  own  home,  a  nursing  home  or  allied  institution, 
rooms  in  an  hotel,  or  the  hospitality  of  some  sympa- 
thetic friend.  But  the  point  must  not  be  overlooked  that 
the  decision  as  to  where  the  cure  shall  be  carried  out  must 
be  influenced  by  the  question  of  nursing.  Someone 
has  to  look  after  the  invalid  systematically.  Nothing 
will  avail  if  personal  attention  be  haphazard  and  in- 
different ;  nothing  can  be  more  unsatisfactory  than  for 
the  care  of  a  neurasthenic  individual  to  be  irregularly 
shared  by  a  number  of  friends  or  relatives,  however  kind 
they  may  be.  On  the  contrary,  it  is  essential  that  one 
particular  person,  chosen  for  special  personal  qualities  and 
abilities,  shall  be  responsible  for  the  nursing  and  every- 
thing incidental  thereto,  and  it  is  rare  for  the  right  quali- 
ties for  the  particular  patient  to  be  found  in  his  or  her 
immediate  circle.  The  very  anxiety  of  near  and  dear  ones 
to  help  hinders  the  carrying  out  of  their  good  intentions  ; 
too  strong  a  personal  interest  in  the  sufferer  tends  to 
make  their  conduct  of  the  case  unsatisfactory.  Our 
previous  observations  about  emotional  feeling  and  judg- 


194  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

ment  again  apply  here.^  Many  reasons  occur  why  one 
might  have  thought  that  this  would  not  be  so,  but  the 
hard  facts  of  experience  show  that  kindly  rela^tives  and 
friends  make  the  worst  nurses,  in  average  circum-stances, 
for  those  dear  to  them.  Of  course,  we  all  know  of 
brilliant  exceptions  by  which  this  harsh  rule  is  lovingly 
proved,  and  when  the  experienced  physician  has 
reason  for  believing  that  some  devoted  friend  ca.n 
safely  be  entrusted  with  the  difficult  task  of  restor- 
ing his  patient  to  health,  he  will  wisely  act  in  accor- 
dance with  his  observations ;  but  it  remains  an  axiom 
that  a  stranger  is  to  be  responsible  for  the  nursing, 
and  the  services  of  a  trained  nurse  must,  therefore, 
be  obtained. 

Again,  what  has  been  said  about  help  from  relatives 
during  treatment  equally  applies  to  one's  experience  as 
to  the  effects  of  home  surroundings.  People  suffering 
from  nervous  disorders  certainly  do  not  get  on  so  quickly 
in  their  own  homes  as  they  do  elsewhere.  Exceptions 
admitted,  this  is  a  serious  consideration.  In  practice  it 
amounts  to  this,  that  it  is  in  the  best  interest  of  the  in- 
vahd  that  he  makes  up  his  mind  to  part  from  family 
conditions  for  the  time  being  and  undergo  treatment 
away  from  home.  If  away  from  home,  and  in  charge  of  a 
nurse,  it  is  difficult  to  find  anything  better  than  a  good 
nursing  home  or  special  home  for  nervous  troubles. 
Very  often,  of  course,  the  question  of  expense  has  to  be 
closely  considered,  but  on  this  point  there  is  little  to  be 
said  in  favour  of  rooms  in  a  private  house  or  hotel.  In 
convalescence  it  is  sometimes  advantageous  for  the 
invahd  to  go  away  under  such  conditions,  but  during  the 
early  part  of  the  rest-cure  routine  it  is  very  unsatisfac- 
tory for  patient  and  nurse  to  be  boxed  up  in  limited 
accommodation  day  after  day.  Then,  again,  in  a  proper 
home  there  is  a  certain  amount  of  beneficial  change  in 

1  Cf.  Part  I,  chap,  ii, 


THE  REST  CURE  195 

regard  to  nursing ;  when  the  special  nurse  goes  off  duty 
some  other  trained  person  takes  her  place,  and  thus 
the  danger  of  harm  being  done  through  the  good  in- 
tentions of  a  kindly  visitor  who  may  be  called  in  to  help 
is  obviated.  But  let  it  be  particularly  noted  that  the 
home  chosen  must  be  up-to-date  in  its  equipment,  and 
managed  in  a  thoroughly  efficient  way.  Much  as  one 
may  sympathize  with  the  directors  of  nursing  homes 
who  endeavour  to  accommodate  invalids  inexpensively, 
one  cannot  overlook  the  fact  that  to  administer  an  in- 
valid institution  in  a  fu-st -class  manner  is  an  expensive 
matter  ;  therefore  people  must  not  expect  to  get  efficient 
nursing,  dieting  and  attention  unless  they  are  prepared 
to  meet  a  heavy  biU.  Disappointing  as  frequently  are 
the  results  of  treatment  carried  out  at  home,  neverthe- 
less, where  expense  is  a  difficulty,  it  is  better  to  secure 
the  services  of  a  good  nurse,  and  make  the  best  of  things, 
than  to  seek  the  indifferent  assistance  of  an  inefficient 
home.  Sometimes  a  friend  will  come  to  the  rescue  and 
accommodate  nurse  and  patient,  but  in  any  case  it  is  very 
necessary  that  the  place  chosen  shall,  if  possible,  be  acces- 
sible to  the  doctor  supervising  the  treatment.  If  things 
cannot  be  arranged  so  that  the  physician  who  has  advised 
the  rest-cure  can  see  that  it  is  carried  out  properly,  then 
he  should  arrange  that  some  other  practitioner  who  can 
visit  the  invalid  regularly  is  deputed  to  take  charge.  It 
is  most  helpful  to  the  invalid  to  know  that  professional 
help  is  always  at  hand  should  it  be  needed  urgently. 
Confidence  is  strained  if  the  doctor  supervising  the  treat- 
ment is  not  readily  accessible. 

Having  considered  the  question  of  locality,  let  us  now 
see  wha,t  cii'cumstances  have  to  be  considered  in  securmg 
the  services  of  a  reliable  nurse.  At  once  let  it  be  said  that 
the  nursing  of  neurasthenic  or  mentally  disturbed  patients 
calls  for  so  much  special  experience  that  it  is  fair  neither  to 
nurse  nor  to  patient  to  employ  anyone  who  has  not  taken 
charge  of  similar  cases  before.    In  nursing,  as  in  other  pro- 


196  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

fessions,  individual  workers  follow  out  their  own  special 
tendencies.  It  has  to  be  remembered  that  the  nursing  of 
nervous  people  calls  for  considerable  self-confidence,  tact 
and  persuasiveness.  There  are  many  difficult  passages 
to  be  negotiated,  many  little  irritations  that  will  want 
soothing  down.  The  morbid  mental  outlook  has  to  be  met 
with  just  the  right  amount  of  sympathy.  Fear  has  to  be 
overcome,  anxious  relatives  must  be  dealt  with  kindly 
but  firmly.  The  doctor  only  sees  the  patient  for 
relatively  a  very  short  time  ;  the  nurse  is  there  practi- 
cally all  the  time,  not  only  helping  the  patient  with 
troublesome  symptoms,  but  also  superintending  special 
treatments,  such  as  massage  and  electricity.  Then, 
again,  the  nurse  has  the  responsibility  of  seeing  that 
sufficient  rest  and  sleep  are  obtained  ;  she  has  to  report 
accurately  as  to  the  amount  and  kind  of  sleep  that  is 
being  secured  ;  also  as  to  the  effects  of  any  sedatives 
that  may  be  given.  Thus,  whilst  her  personality  and 
strength  of  mind  are  two  great  assets,  nevertheless  it  is 
not  for  her  to  overawe  her  tired  and  distressed  charge, 
nor  to  exert  and  control  by  sheer  force  of  human  will. 
Strength  has  to  be  coaxed  back  and  health  demons- 
trated ;  thought  has  to  be  led  into  right  channels,  and 
not  forced  willy-nilly.  Naturally,  the  factor  of  suggestion 
is  as  helpful  to  the  nurse  as  to  the  doctor,  but  it  should^ 
be  the  suggestion  of  restfulness  and  confidence  conveyed 
by  her  general  mental  atmosphere.  She  must  calm  by 
her  tranquillity,  brighten  by  her  cheerfulness  and  win 
confidence  by  straight  dealing.  The  happy  medium 
of  just  enough  sympathy  associated  with  the  right 
manifestation  of  authority  is  necessary.  As  any  illness 
may  so  react  as  to  produce  a  neurasthenic  condition, 
it  follows  that  every  trained  nurse  should  know  how 
to  deal  with  nervous  disorders.  Whatever  the  nature 
of  the  case  to  which  she  is  called  "  nerves  "  may  be 
found  to  figure  prominently.  It  is  because  nurses  so 
often   find  themselves   at   a   loss   when   confronted   by 


THE  REST  CURE  197 

neurasthenia  that  one  sometimes  hears  of  patients 
criticising  them  adversely.  The  invalid  instinctively 
feels  that  however  excellent  the  nurse's  attention  may 
be  in  regard  to  material  routine,  she  has  failed  to  grasp 
his  difficulties  in  the  ultimate  field  of  mind.  It  sometimes 
happens  that  a  nurse  successfully  looks  after  an  operation 
case,  and,  although  the  technical  details  of  surgical  nursing 
are  efficiently  carried  out,  yet  the  patient  does  not  seem 
to  make  progress  satisfactorily.  Then  perhaps  a  more 
understanding,  although  less  highly  trained,  attendant 
takes  charge  of  the  case,  and  rapid  progress  is  at  once 
made.  Nm^ses  should  be  careful  to  study  sick  persons 
not  only  as  cases  but  as  human  beings.  Sick  people  are 
not  machines  to  be  cared  for  without  thought  of  their 
anxieties  and  mental  difficulties. 

Patients  frequently  ask  for  a  nurse  who  will  under- 
stand them,  meaning  thereby  not  merely  that  she  should 
be  proficient  in  technical  nursing,  but  that  she  should 
have  a  sympathetic  comprehension  of  their  tempera- 
ment and  feehngs.  The  very  thorough  training  which 
invalid  nurses  undergo  to-day,  excellent  as  it  is  in  many 
special  branches,  would  nevertheless  be  greatly  improved 
if  more  special  attention  were  given  to  instruction  as  to 
the  functions  and  common  vagaries  of  the  mind  and 
nervous  system.  By  no  means  is  it  suggested  that  exact- 
ing patients  should  have  things  all  their  own  way  on  the 
ground  that  their  sensitive  feelings  must  be  respected. 
Selfish  people  who  think  only  of  themselves  and  make  no 
attempt  to  help  the  doctor  or  nurse  should  be  dealt  with 
firmly.  But,  on  the  other  hand,  the  nurse  who  knows 
iter  work  can  well  afford  to  modify  the  details  of  strict 
routine  to  suit  her  charge,  where  there  are  nervous  diffi- 
culties existing.  To  give  way  a  little  in  the  matter  of 
arrangement  of  bed  and  furniture,  as  also  in  regard  to  the 
general  regime  of  the  sick  room,  may  be  a  gTeat  source  of 
comfort  to  the  invahd  and  not  in  the  least  interfere  with 
essentials.    The  nurse  may  maintain  her  authority  weU, 


198     THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

letting  the  sufferer  see  she  thoroughly  understands  his 
point  of  view.  If  anything  has  to  be  done  that  is  un- 
pleasant to  the  invalid,  it  need  not  be  done  roughly,  and 
he  may  weU  be  told  beforehand  what  is  going  to  be  done, 
and  how  it  is  in  his  best  interests  that  it  should  be  done. 
Patients  have  every  reason  to  complain  when  they  are 
made  uncomfortable  for  the  sake  of  some  routine  measure 
which  has  no  real  importance. 

Apart  from  the  questions  of  locaUty  and  nursing, 
success  of  the  rest-cure  depends  on  the  general  sur- 
roundings and  daily  programme.  To-day  the  physician 
studies  the  effects  of  environment  in  illness  much  more 
closely  than  formerly,  reahzing  how  important  it  is  that 
the  tired  nervous  system  shall  be  assisted  in  attaining 
renewed  activity  by  just  the  right  kind  of  impressions 
from  without.  He  knows  that  cheerful  surroundings  and 
the  companionship  of  bright  healthy  attendants  are 
essential  for  the  purpose  in  view.  Again,  special  con- 
ditions require  special  modifications  of  environment. 
Thus  a  highly  excitable  patient  requires  quiet  and  sooth- 
ing surroundings,  whilst  one  suffering  from  depression 
is  best  helped  by  conditions  designed  to  stimulate  the 
nervous  system.  In  any  case,  to  isolate  an  invalid  in  dull 
and  unsympa/thetic  surroundings,  whilst  overwhelming 
him  with  milk  and  slops,  is  but  a  poor  parody  of  a  cure. 
An  uninteresting  routme  impresses  the  sufferer  with 
morbid  suggestions  and  makes  for  ill-health  instead  of 
health.  The  question  of  seeing  friends  during  a  rest-. 
cm'e  is  a  matter  of  some  importance.  Unfortunately,  as 
already  noted,  it  commonly  happens  that  the  mfluence 
of  near  friends  and  relatives  is  disadvantageous  to  patients 
suffering  from  nem-asthenic  conditions.  As  a  matter  of 
experience  one  finds  they  are  mclined  to  be  pessimistic  ; 
that  they  are  so  impressed  by  the  distressing  symptoms 
that  theh  anxiety  is  conveyed  to  the  invahd.  Thus  they 
continually  subject  him  to  bad  suggestions,  and  help  him 
to  persuade  himself  that  his  case  is  more  serious  and  com- 


THE  REST  CURE  199 

plicated  than  it  really  is.  Certainly  nervous  breakdown 
is  a  serious  and  comj)licated  condition,  but  it  is  a  com- 
paratively straightforward  malady  to  those  who  under- 
stand it  ;  there  is  all  the  difference  betv/een  realizing 
the  serious  nature  of  a  situation  and  regarding  it  as 
practically  beyond  hope.  The  VvT^ong  kind  of  sympathy 
may  prolong  a  nervous  illness  for  many  unnecessary 
months.  Invalids  are  very  sensitive  as  to  what  is  thought 
about  them,  and  quickly  estimate  what  those  about  them 
really  think.  Success  in  treatment  so  largely  depends 
on  the  will  and  determination  to  get  well,  that  every 
adverse  suggestion  must  be  barred  out  and  every  possible 
source  of  pessimism  ehminated.  On  the  other  hand, 
one  sometimes  comes  across  a  very  careless  flippancy 
that  in  its  way  is  just  as  harmful  as  undue  pessimism. 
It. still  sometimes  happens  that  healthy  people  scornfully 
express  their  intolerance  of  "  nerves."  To  scoff  at 
nervous  maladies  is  merely  an  expression  of  ignorance 
about  a  matter  of  urgent  pubhc  importance.  To 
speak  contemptuously  of  nerves  is  to  insult  every  man 
who  has  suffered  sheU-shock  dua^ing  the  great  fight  for 
freedom. 

As  to  relatives  their  attitude  should  be  one  of  watch- 
ful sympathy.  Under  the  guidance  of  the  physician 
they  should  endeavour  to  support  the  patient  through 
his  trouble  whUst  they  have  to  look  after  him.  Over- 
whelming sympathy  should  be  avoided,  on  the  one  hand, 
and,  on  the  other,  cruel  attempts  to  laugh  him  out  of  his 
illness  are  to  be  deprecated.  Recognizing  that  treatment 
invariably  takes  some  time,  friends  should  avoid  frequent 
questioning  as  to  feelings  and  symptoms.  The  patient 
obviously  is  ill  and,  therefore,  feels  it.  When  he  feels 
well  and  strong  he  will  no  longer  need  to  be  under  treat- 
ment ;  the  fact  that  he  is  mider  treatment  indicates  that 
he  is  still  unwell.  No  good  at  all  can  be  done,  and  progress 
will  not  be  hastened  by  repeated  questioning  and  endea- 
vours to  obtain  detailed  information  in  the  first  few 


200  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

weeks  of  the  cure.  It  is  for  these  reasons  that  visits  and 
letters  from  friends  have  to  be  stringently  regulated. 
Relatives  are  naturally  anxious  to  have  good  news  as 
soon  as  possible  ;  in  the  interests  of  the  sick  person  they 
must  restrain  their  solicitude  for  the  time  being. 


CHAPTER  III 

THE    REST   CURE 

{B)  Routine 

Daily  routine — Sleep — Nourishment — Massage — Occupation — 
A  typical  programme. 

THE  patient  having  been  installed  in  a  bright  and 
restful  room  with  a  reliable  nurse  in  charge,  the 
daily  programme  has  next  to  be  drawn  up,  and  one 
of  our  objects  being  to  rest  the  tired  nervous  system, 
the  question  of  how  long  the  invaUd  shall  stay  in 
bed  comes  up  for  immediate  decision.  Under  the 
influence  of  the  natural  desire  of  patient  and  friends 
to  shorten  the  treatment  as  much  as  possible,  the  ten- 
dency is  to  order  too  little  rather  than  too  much  rest.  As 
a  rule  six  weeks  may  be  regarded  as  the  minimum  time 
for  thorough  rest  where  a  neurasthenic  condition  is  so 
advanced  as  to  make  a  rest  cure  advisable  ;  in  other  forms 
of  breakdown  the  time  required  necessarily  varies  accord- 
ing to  circumstances.  This  does  not  necessarily  mean 
that  he  is  to  stay  in  bed  all  the  time.  It  often 
happens  that  the  same  end  can  be  secured  by  allowing 
a  portion  of  the  day  to  be  spent  on  a  couch,  or,  during 
the  summer,  on  a  reclining  chair  out  of  doors.  In 
many  ways  it  is  better  for  patients  to  rest  and  have 
meals  out  of  doors,  where  this  can  be  arranged  without 
bringing  them  into  contact  with  too  many  other  people. 
Towards  the  end  of  the  time  allotted  for  complete  rest  a 
little  more  walking  about  the  room,  or  up  and  down  the 

201 


202  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

stairs,  or  in  the  course  of  the  journey  to  and  from  the 
garden,  may  be  permitted. 

Although  complete  rest  of  body  is  so  necessary,  it  is 
equally  important  that  rest  of  mind  be  considered 
from  the  point  of  view  of  its  own  special  requirements. 
The  latter  can  be  obtained  either  by  sleep,  or  by  mental 
occupation.  Never  can  it  be  obtained  by  mental  in- 
activity. But  the  right  activity  must  be  secured.  The 
whole  point  of  mental  rest  is  to  change  the  stream  of 
thought  which  has  been  morbidly  centred  in  certain 
directions  into  fresh  and  health-bringing  channels.  The 
mental  process  which  ensures  rest  through  action  and 
new  thought  finds  its  counterpart  on  the  physical  plane, 
for  when  groups  of  brain  cells  have  been  exhausted  by 
one  particular  kind  of  mental  work,  the  exercise  of  the 
mental  faculties  in  a  new  direction  diverts  the  strain  from 
the  tired  cells  and  brings  into  activity  new  sets  that  have 
hitherto  not  borne  stress.  Of  course  when  the  brain 
is  tired  the  fatigue  reacts  through  the  v/hole  nervous 
system,  so  that  any  form  of  intellectual  activity  must 
at  first  be  regulated  with  care.  Each  day  the  invalid 
must  have  a  definite  programme  of  occupation,  covering 
every  hour,  and  allowing  no  time  for  morbid  thoughts 
to  take  possession.  Often  it  is  difficult  at  first  to  per- 
suade the  suSerer  that  he  can  do  anything  at  all  ;  some- 
times it  does  happen  that  exhaustion  is  so  profound  as  to 
prevent  all  activity  for  a  day  or  two.  Nevertheless,  even 
when  this  is  so  the  day  must  not  be  allowed  to  pass  in  a. 
slipshod  manner  ;  gentle  conversation,  being  read  to  from 
suitable  books,  as  much  sleep  as  can  be  secured,  massage, 
meals  and  the  routine  of  the  bedroom,  must  be  made 
between  them  to  fill  up  every  moment. 

Sleep  is  often  enough  a  difficulty.  So  far  as  possible 
drugs  are  to  be  avoided,  but  experience  must  guide  us 
here,  and  each  physician  will  act  according  to  his  own 
judgment  in  individual  instances.  Patients  should  not 
embarrass  the  doctor  by  crying  out  for  sleeping  draughts. 


THEIREST  CURE  203 

Granted  that  a  sleepless  night  is  a  distressing  experience, 
it  should,  however,  be  pointed  out  that  most  of  the  dis- 
tress in  insomnia  comes  from  the  fear  which  arises  from 
it.  As  previously  noted,  where  no  special  activity  is 
called  for  on  the  following  day  a  sleepless  night  is  com- 
paratively harmless  ;  and,  indeed,  where  rest  can  be 
secured  during  the  day  several  bad  nights  can  be  borne 
in  succession  without  the  least  danger  of  anything  un- 
toward happening.  It  is  remarkable  how  a  few  minutes' 
restful  persuasion  from  some  understanding  individual 
enables  a  sleepless  person  to  "  settle  down  for  the 
night  "  and  secure  rest.  Sometimes  sleep  itself  will 
quickly  come  if  the  right  word  be  spoken  at  the  last 
moment.  Comfort  in  bed,  the  right  degree  of  warmth, 
and  a  judiciously  filled  stomach  are  all  important  factors 
in  making  for  sleep.  All  digestive  disturbances  tend  to 
cause  insomnia,  so  that  flatulence  and  constipation — 
particularly  the  latter — must  be  alleviated  by  suitable 
remedies.  Again,  common  sense  tells  us  that  unpleasant 
medicines  or  preparations  likely  to  set  up  violent  action  in 
the  stomach  should  not  be  given  at  bed-time  ;  a  point 
in  nursing  that  should  be  more  carefully  noted  than  often 
is  the  case.  Such  matters  as  having  a  light  in  the  room, 
or  a  fiire,  must  be  decided  by  individual  requirements,  but, 
in  any  case,  the  best  possible  ventilation  is  desirable, 
and  one  knows  of  instances  in  which  sleeplessness  has 
been  cured  by  the  simple  expedient  of  opening  wide  the 
bedroom  windows.  Then,  as  to  nourishment,  inva/Uds 
undergoing  a  rest  cure  should  have  three  meals  a  day, 
irrespective  of  afternoon  tea.  Vv^e  v/ant  our  patients  to 
put  on  weight  ;  we  want  them  to  fill  out,  and  to  be 
stouter  in  every  way.  Therefore,  we  give  them  a 
full  diet,  and  see  to  it  that  they  have  plenty  of  fat. 
It  is  for  this  reason  that  it  has  been  a  custom  to  give 
large  quantities  of  milk  during  a  rest  cure,  although 
there  are  notable  disadvantages  in  so  doing  both  from 
the  point  of  view  of  digestion  and  appetite.    Besides, 


204  THE  PKOBLEM  OF  NERVOUS  BREAKDOWN 

neurasthenic  people  require  more  fat  in  their  brains  as 
well  as  in  then  bodies.  Extra  milk  up  to  a  pint 
or  two  daily  is  often  found  helpful,  but  there  is  no 
better  way  of  administering  additional  fat  than  by 
giving  such  preparations  as  ohve  oil  and  cod-hver  oil. 
Some  people  prefer  the  former  and  can  take  it  without 
difficulty,  but  as  a  rule,  cod-liver  oil  is  better  borne.  It 
may  be  given  two  or  three  times  a  day,  but  there  are 
advantages  in  giving  one  large  dose,  say  up  to  two  table - 
spoonfuls  at  bed-time  nightly.  Those  who  find  them- 
selves unable  to  take  oils  in  simple  form  can  usually 
ingest  one  of  the  emulsions  without  difficulty.  There  is 
this  to  be  said  about  oils  as  helpful  in  building  up  a 
broken  down  nervous  system.  Nerve-cells  depend  in 
part  for  their  successful  working  on  a  delicate  film  of 
fatty  substance.  This  is,  indeed,  a  phosphcrised  fat — 
lecithin — and  contains  most  of  the  phosphorus  held 
in  the  nervous  system.  One  may  consider  this  lecithin 
as  part  of  the  insula,ted  material  which  separates  the 
tiny  nerve-fibres  in  the  same  way  as  silk  and  india- 
rubber  coverings  separate  the  wires  of  electrical  apjDaratus. 
The  next  point  to  be  observed  is  that  in  the  absence 
of  regular  exercise,  means  must  be  adopted  to  main- 
tain the  limbs  and  muscular  system  generally  in  a 
healthy  state,  as  well  as  to  assist  the  circulation. 
When  people  remain  recumbent  for  a  long  time,  the 
muscles  become  flabby,  whilst  the  circulation  becomes 
sluggish  and  there  is  a  corresponding  slackness  in  the 
discharge  of  waste  matters  from  the  system.  For  these 
reasons,  therefore,  energetic  stimulation  which  does  not 
over-tne  the  invahd  must  be  regarded  as  a  useful  part  of 
the  rest-cure  routine.  Of  aH  means  of  securing  this  effect, 
massage  is  the  most  helpful  and  convenient.  There  is  no 
mystery  about  it,  as  it  is  simply  a  scientific  method  of 
rubbing  and  kneading.  People  sometimes  talk  about 
massage  as  if  it  had  special  healing  properties,  and  often 
one  hears  it  said  that  some  one  who  has  been  ill  for  a 


THE  REST  CURE  205 

long  time  has,  among  other  things,  "  tried  massage," 
as  if  that  were  a  specific  remedy.  Rubbing  and 
pounding  are  time-honoured  methods  of  restoring  life 
to  flagging  human  bodies ;  such  processes  cause  con- 
traction in  muscular  fibres  and  help  to  drive  the  blood 
through  areas  where  there  is  a  tendency  to  stagnation. 
In  addition  to  these  simple  results,  massage  may  be 
carried  out  in  such  a  way  as  to  be  very  sedative,  and  is 
then  useful  in  allaying  restlessness  and  promoting  sleep. 
Moreover,  rubbing  the  abdomen  is  very  useful  in  setting 
up  regular  healthy  contractions  of  stomach  and  bowels, 
thereby  aiding  digestion  and  preventing  constipation  ; 
whilst  achieving  this  it  also  disperses  accumulations  of 
gas  and,  therefore,  alleviates  uncomfortable  symptoms 
occasioned  by  flatulence.  Special  points  to  be,  observed 
in  making  use  of  massage  as  an  aid  to  other  methods  of 
treatment  in  neurasthenic  conditions  are  that  it  should 
not  be  too  vigorous  or  given  for  too  long  a  time ;  also  that 
where  there  is  great  excitement  the  strokes  should  be 
light  and  rhythmical.  On  the  contrary  when  a  sedative 
effect  is  desired,  these  long  rhythmical  movements  should 
be  apphed  to  the  spine  rather  than  to  the  Hmbs.  Com- 
prehensive general  rules  cannot  well  be  laid  down  as 
individual  requirements  vary  so  very  much  ;  but  it  may 
well  be  remembered  that  long  contin.ued  vigorous  handling 
will  cause  fatigue,  restlessness  and  disturbed  sleep. 
However,  difficult  though  it  may  be  to  express  in  words 
the  difference  between  gentle  and  vigorous  massage,  one 
can  be  more  definite  about  time.  As  a  rule,  it  is  well 
to  commence  with  ten  minutes'  rubbing,  after  a  few  days 
increasing  by  five  minutes  every  third  day  until  haK  an 
hour's  treatment  can  be  comfortably  borne.  The  best 
time  for  the  application  is  in  the  morning,  unless  a 
special  sedative  effect  is  required  later  on  in  the  day. 

As  to  occupation  emphasis  has  been  laid  on  the 
necessity  for  keeping  patients  continually  occupied  during 
their  rest   cure,   but    it  is  by  no    means  easy  to    find 


206  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

suitable  tasks  in  the  ea.rly  stages.  The  patient  has  to 
be  impressed  with  the  importance  of  doing  something, 
but  not  infrequently  raises  objections  whilst  admitting 
the  fact.  Sometimes  one  is  told  that  using  the  eyes 
produces  terrible  fatigue,  accompanied  perhaps  by  head 
sensations.  If  this  is  accepted,  it  rules  out  almost  every- 
thing one  can  suggest  for  the  patient  to  do  himself. 
But  the  impasse  has  to  be  overcome  somehow  or  other. 
Fortunately  it  seldom  happens  that  patients  will  assert 
that  they  cannot  give  attention  to  an  object  or  to 
a  book  for  a  few  minutes  at  any  rate.  Even  this  short 
time  serves  as  a  foundation  upon  which  to  build. 
Let  them  be  assured  that  the  use  of  their  attentive 
powers  for  even  a  few  minutes  daily  is  better  than 
nothing,  'and  all  that  is  required  for  the  time  being  ; 
then  it  is  usually  easy  by  sympathetic  encouragement 
to  increase  the  time  given  to  attentive  tasks  as  the 
days  pass  by.  The  fact  remains,  however,  that  where 
concentration  is  found  to  be  distressing,  the  few  minutes 
given  to  a  task  represent  an  inappreciable  fraction  of 
the  day's  routine,  and,  therefore,  some  continuous  com- 
panionship is  essential.  Someone  must  be  at  hand  to 
read,  to  write  letters,  to  dkect  the  invalid's  attention 
into  the  right  channel  dming  these  first  trying  days. 
Nevertheless  we  may  now  consider  a  few  occupations  that 
are  suitable  for  patients  who  can,  without  difficulty, 
devote  an  appreciable  time  to  them  daily.  Reading,  of 
course,  is  a  great  resource,  but  its  disadvantages  must  not 
be  overlooked.  Although  useful  in  diverting  thoughts  from 
illness,  it  nevertheless  frequently  results  in  the  invalid 
thinking  about  himself  in  relation  to  what  he  has  been 
reading.  The  right  books  being  selected,  the  patient 
should  be  allowed  to  read  only  for  periods  of  thirty  to 
forty  minutes  at  a  time  during  the  day,  and  not  for  hour 
after  hour. 

Those  which  occupy  hand  as  well  as  brain  are  the  most 
helpful  of  all.     Anything  that  calls  for  manipulation  as 


THE  REST  CUHE  207 

well  as  thought  helps  in  the  recovery  of  nerve-tone 
sooner  than  any  purely  mechanical  process  such  as 
knitting.  Only  too  often,  when  people  seem  to  be 
engaged  in  needlework,  their  thoughts  are  all  the  time 
dwelling  on  their  troubles.  The  movements  for  knitting, 
stitching,  or  embroidery,  are  largely  automatic,  and  do 
not  serve  to  divert  the  mind.  But  where  a  task  is 
given  that  requires  attention  as  well  as  manual  move- 
ments for  its  accomplishment  a  twofold  result  is 
achieved.  For  these  reasons  such  occupations  as  putting 
together  jig-saw  puzzles,  learning  new  kinds  of  needle- 
work, drawing,  painting  or  type-writing,  are  very  useful ; 
all  except  the  latter  can  be  conveniently  carried  out  in 
bed  and  even  type-writing  is  not  impossible  to  those  who 
possess  one  of  the  lighter  makes  of  machines.  Such 
occupations  may  be  varied  by  various  other  kinds  of 
fancy  work,  such  as  making  baskets  or  mats.  But  the 
disadvantages  about  automatic  movements  previously 
noticed  applies  to  some  of  these  things  as  soon  as  the 
patieiit  becomes  proficient  at  them.  The  great  thing  is 
to  secure  variety  and  avoid  automatism. 

Once  the  invaUd  is  able  to  get  up  and  about  a  variety 
of  health-giving  interests  come  within  his  scope.  Light 
gardening  jobs,  out-door  sketching,  the  collection  of 
flov/ers  and  grasses,  carpentry  and  so  forth,  can  all  be 
undertaken.  V/hether  in  bed  or  out  of  it  the  invalid 
should  ha.ve  a  daily  programme  upon  which  to  work  ; 
where  he  is  difficult  to  deal  with  in  this  respect,  the 
special  tasks  ordered  should  be  written  down  ;  but  as  time 
^oes  on  the  pa.tient  becomes  able  to  suggest  his  own  little 
jobs,  and  such  co-opera,tion  between  him  and  his  doctor 
is  very  desirable  and  a  sure  sign  of  improvement. 

We  are  now  in  a  position  to  draw  up  a  programme  for 
a  typical  d£iy  under  rest-cure  routine,  and  the  follow- 
ing represents  daily  programmes  in  constant  practical 
use.  It  is  to  be  noted  that  the  active  day  is  of  some 
thirteen  to  fourteen  hours  duration,  with  a  two  hours 


208  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

break  in  the  afternoon.  Breakfast  at  8.0  is  followed 
by  an  hour  or  so  for  looking  at  papers  or  any  letters  that 
may  have  been  permitted.  From  9.30  to  11.0  is  occu- 
pied by  the  routine  of  getting  up,  for  those  who  are  able 
to  do  so,  whilst  a  process  corresponding  to  dressing  fills 
up  the  time  for  patients  remauiing  in  bed.  The  little  inci- 
dentals of  the  toilet,  when  performed  'vvithout  haste,  take 
up  a  surprising  amount  of  time,  and  people  seldom  find 
they  have  many  spare  moments  in  the  early  morning 
where  a  regular  method  is  pursued  daily.  No  slackness 
must  be  permitted,  and  things  such  as  shaving,  hair- 
dressing  and  tidying  up  generally  must  be  conscientiously 
carried  out.  Where  electricity  or  massage  is  ordered  it 
is  usually  at  least  11.30  before  the  morning's  preparation 
is  finished. 

At  11.0  or  11.30,  as  the  case  may  be,  wa,rm  milk  or 
special  food  is  taken  with  a  few  biscuits.  With  the  mid- 
day meal  at  1.0  o'clock  there  remains  an  hour  and  a  half 
to  be  spent  in  one  of  the  occupations  lately  considered. 
Luncheon  occupies  about  half  an  hour,  and  is  followed 
by  a  period  of  half  an  hour,  durmg  which  papers  or  books 
may  be  looked  at.  Each  afternoon  between  2.0  and 
4.0  o'clock — in  winter  from  1.45  to  3.0 — the  patients 
rest,  lying  down  with  drawn  curtains  intent  to  sleep 
if  possible.  A  short  period  of  getting  up  again  precedes 
a  good  tea  at  4.15.  From  5.0  to  7.0  o'clock  time 
is  given  to  reading,  v/riting,  doing  a  jig-saw  puzzle,  or 
a  little  light  work,  and  early  evening  passes  so  quickly 
that  under  well-directed  conditions  the  hour  for  the 
evening  meal  arrives  before  the  invalid  has  time  to  be 
bored,  or  to  think  about  himself.  At  9.0  o'clock  pre- 
parations for  the  night  begm,  and  by  10.0  p.m.  the  room 
should  be  darkened. 


CHAPTER  IV 

DIET   AND    SOME    OTHER    POINTS    IN 
CONVALESCENCE 

Nerve  energy  dependent  on  nutrition — Diet  in  nervous  maladies — 
Personal  idiosyncrasies — Advantages  and  disadvantages  of  milk — 
A  mixed  diet — General  principles  of  diet — Sugar — Cheese — Stimu- 
lants— Baths — Effects  on  nervous  system — "  Reaction  " — Impor- 
tant rules — Clothing — Natural  heat — Exercise  and  body  tempera- 
ture. 

IT  is  helpful  for  people  convalescent  from  nervous 
breakdown  or  subject  to  failure  of  nerve -tone  to  know 
what  to  eat  and  to  drink,  what  to  do  about  baths  and  to 
what  extent  their  clothing  shall  be  arranged  to  meet 
their  special  requirements.  Nerve-energy  is  the  active 
force  on  which  every  part  of  the  body  depends  for  its 
power  to  carry  out  its  part  in  the  grand  chain  of  physical 
life  ;  and  nerve-energy  is  dependent  on  what  nourish- 
ment is  taken  into  the  system.  Nature,  indeed,  protects 
the  nervous  system  in  the  matter  of  nourishment,  indi- 
cating its  paramount  position  in  the  human  body  ;  so 
much  so  that  in  starvation  all  other  organs  suffer  first, 
and  what  little  food  remains  in  the  system  is  reserved 
and  given  to  the  brain.  Observations  have  been  made 
showing  that  where  people  have  been  starving  the  muscles, 
large  glands,  and  even  the  heart  itself  shrink  and  lose 
substance  long  before  the  brain  suffers  in  this  way,  thus 
evidencing  Nature's  protective  influence.  However, 
when  it  is  a  matter  of  nourishment  under  conditions 
of  ample  diet,  there  is  no  indication  that  a  selective 
action  is  exercised  on  behalf  of  the  nervous  system  ; 
that  is  to  say  the  popular  supposition  that  certain 
p  209 


210  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

principles  are  extracted  from  the  food  and  given  to  it 
is  fallacious.  Certainly  it  is  true  that  the  brain  contains 
phosphorus,  but  it  does  not  contain  more  phosphorus 
than  can  be  obtained  from  an  ordinary  mixed  diet  ; 
moreover,  its  requirements  in  this  respect  being  very 
limited  extra  phosphorus  in  the  food  serves  no  useful 
purpose.  It  is  popularly  understood  that  certain 
articles  of  diet,  such  as  fish,  are  particularly  nourishing 
to  the  nervous  system,  owing  to  the  fact  that  they  con- 
tain a  rather  higher  percentage  of  phosphorus  than  other 
things.  But  there  is  not  the  slightest  evidence  that  these 
particular  food  substances  are  especially  valuable  in  the 
treatment  of  neurasthenic  states.  The  fact  is  that  with 
a  mixed  diet  the  various  organs  of  the  body  receive  their 
nourishment  in  a  general  way  from  the  blood  stream, 
and  that  each  can  obtain  from  such  a  diet  everjrthing 
that  is  required  for  its  particular  purpose,  and  to  sustain 
its  own  particular  constitution.  In  other  words,  every- 
thing that  is  good  food  for  one  part  of  the  body  is  good 
food  for  aUthe  rest  ;  any  ample  nourishing  diet  is  a  good 
nerve  diet.  Preparations  that  enable  us  to  give  the 
essential  principles  of  a  mixed  diet  in  concentrated  form 
are,  of  course,  good  invalid  foods  ;  any  good  invaUd  food 
nom'ishes  the  brain  and  nerve  tissues  excellently.  All  the 
reUable  food  preparations  advertised  as  being  helpful  in 
neurasthenic  states  are  virtually  concentrations  of  such 
things  as  milk,  eggs,  or  meat.  Let  it  be  noted  that  to  be 
effective  a  diet  must  contain  fats,  carbohydrates  and 
proteids.  If  a  concentrated  food  preparation  is  deficient 
in  fats,  sugars,  or  flesh  principles  it  must  to  that  extent 
fail  as  an  aU-round  nutritive  for  the  nervous  or  any  other 
system. 

It  follows,  then,  that  the  nerve  patient's  diet  must 
be  as  full  and  varied  as  possible,  being  supplemented 
as  may  be  decided  by  whatever  concentrated  prepara- 
tion is  convenient.  Many  such  preparations  are  very 
useful  in  their  way.    Thus  it  is  not  necessary  to  lay  down 


DIET  IN  CONVALESCENCE  211 

very  rigid  rules  of  diet  for  those  who  are  neurasthenic, 
or  to  trouble  them  with  a  diet-sheet  that  will  make  their 
meals  a  burden  to  them  or  destroy  the  peace  of  the 
kitchen.  Leaving  out  of  consideration,  for  the  present, 
those -unfortunate  persons  whose  state  of  health  is  such 
that  they  are  practically  confined  to  their  rooms,  I  may 
say  at  once  that  neurasthenic  people  should  partake 
plentifully  of  a  good  mixed  diet.  Certainly  limitations 
of  digestive  capacity  must  not  be  overlooked,  but, 
having  made  a  note  of  the  particular  articles  of  diet  that 
upset  him,  he  should  proceed  to  exclude  them  rigidly 
from  his  table,  and  enjoy  his  meals  without  bothering 
more  about  them.  One  person  can  eat  anything  except 
cheese  ;  another  cannot  digest  shell-fish  ;  yet  others  are 
upset  by  cucumber ;  a  few  even  find  eggs  disagree  with 
them.  Such  idiosyncrasies  are  innumerable,  and  some 
appear  trivial.  But  it  is  foolish  to  risk  a  disturbance  of 
digestion  which  may  influence  health  and  work  for  some 
days.  Far  better  to  make  it  a  rule  of  life  to  avoid  those 
particular  foods  that  always  disagree.  It  is  not  at  ail 
easy  to  prescribe  successfully  a  nourishing  diet  for  people 
who  tell  you  that  they  cannot  eat  this  and  cannot  eat 
that  without  being  upset  by  it,  and  in  this  connection  one 
has  to  utter  a  word  of  warning.  The  neurasthenic  person 
who  is  bothered  by  dyspeptic  symptoms  is  often  inclined 
to  over-estimate  their  importance  and  the  sufferings  he 
is  subject  to  from  them,  with  the  result  that  he  will  un- 
necessarily reduce  the  list  of  things  he  feels  he  can  digest. 
Of  course,  milk  is  always  useful  in  dyspepsia,  but  it  is  a 
mistake  to  think  that  by  the  consumption  of  a  certain 
number  of  glasses  of  milk  daily  great  progress  will  neces- 
sarily be  made  in  either  building  up  the  nervous  system 
or  fattening  the  body.  By  itself  milk  is  not  very  easy  of 
digestion  ;  for  when  it  comes  into  contact  with  the  diges- 
tive juices  a  heavy  curd  is  formed  which  takes  time  to 
dissolve.  Where  this  curd,  as  sometimes  happens,  is  not 
thoroughly  digested,  the  residue  ferments,  with  the  pro- 


212  THE  PHOBLEM  OF  NERVOUS  BREAKDOWN 

duction  of  further  distressing  symptoms.  This  is  why  eo 
many  people  cannot  take  milk  and  find  that  it  is  "  too 
heavy,"  and  therefore  disagrees  with  them.  But  this 
is,  indeed,  easily  remedied,  because  the  addition  of  a 
small  proportion  of  soda-water  to  the  milk  before  it  is 
taken  will  result  in  the  formation  of  a  much  lighter  curd 
which  is  more  readily  digested.  This  process  can  be 
carried  even  further  by  the  addition  of  sodium  citrate, 
which,  in  the  proportion  of  one  grain  to  one  ounce  of  milk, 
will  produce  a  curd  which  is  light  and  very  readily  dealt 
with  by  the  digestive  juices.  Thus  there  is  no  reason  why 
a  great  many  people  who  are  now  debarred  from  the 
benefits  of  milk  through  misunderstanding  its  proper  use 
should  not  be  enabled  to  take  it  with  the  greatest  advan- 
tage to  their  general  strength  and  nourishment.  For 
some  others  peptonised  milk  or  "  sour  "  milk,  will  be 
found  more  suitable  preparations.  For  the  rest  let  the 
nerve  patient  take  as  mixed  a  diet  as  he  possibly  can  of 
things  that  experience  has  taught  him  will  not  be  pro- 
ductive of  unfortunate  consequences.  If  the  number  of 
these  things  be  small,  then  let  him  begin  with  the  milk 
preparations,  eggs  lightly  boiled,  fish,  thin  bread  and 
butter,  and  similar  things,  till  such  time  as  the  course  of 
treatment  he  is  undergoing  so  far  nerves  the  tone  of  the 
stomach  that  he  can  digest  a  heavier  diet. 

Unfortunately  for  themselves,  many  neurasthenic  people 
allow  themselves  to  be  led  away  by  fads  and  crazes  in  the 
matter  of  diet.  Their  malady  predisposes  them  to  in- 
fluences from  without  which  in  health  they  would  be 
proof  against,  and  in  the  endeavour  to  gain  better  health 
they  are  inclined  to  listen  rather  favourably  to  the 
strongly-expressed  views  of  cranks.  The  study  of  rational 
dietetics,  with  the  object  of  keeping  up  general  and  nerv- 
ous health,  as  also  the  adjustment  of  diet  to  the  conditions 
of  life  as  it  is  lived  in  our  big  cities  and  business  centres, 
is  perfectly  reasonable,  but  why  is  it  that  so  many  dietists 
rush  away  to  extreme  views  ?    The  most  elementary  study 


DIET  IN  CONVALESCENCE  213 

of  Man,  the  organs  with  which  he  is  provided,  and,  per- 
haps even  more,  the  realization  of  his  accepted  place  in 
the  animal  kingdom,  should  convince  us  of  the  impor- 
tant fact  that  he  is  evidently  adapted  for  a  thoroughly 
mixed  diet.  Still,  this  tendency  to  dietetic  fads  exists, 
and  is  productive  of  many  wrong  attempts  at  construct- 
ing a  rational  diet-sheet  on  the  part  of  people  who  realize 
that  they  have  made  progress  in  this  direction,  and 
honestly  wish  to  benefit  their  fellows.  There  is  no  doubt 
that  many  of  the  existing  food  fads,  such  as  vegeta- 
rianism, fruitarianism  and  the  anti-salt  crusade,  owe  their 
origin  to  amateur  experiments  in  dietetics  on  the  part 
of  neurasthenic  people  who  have  been  unsatisfied  in  their 
demands  for  directions  from  their  doctors. 

The  complaint  is  sometimes  made  that  doctors  are 
content  with  giving  a  bare  general  outline  of  the  principles 
of  diet,  leaving  the  bewildered  inquirer  in  a  more  hopeless 
state  of  mind  than  he  was  before  ;  but  people  are  often 
very  exacting  in  their  questions  as  to  diet.  The  average 
patient  who  inquires  as  to  his  diet  wants  to  know  exactly 
how  much  bacon  he  may  have  for  breakfast,  and  how 
many  eggs  he  must  take.  He  wants  to  know  whether  he 
is  to  have  a  four-course  lunch  with  a  bottle  of  wine  in 
the  middle  of  the  day,  and,  if  so,  what  each  course  shall 
consist  of.  He  is  even  more  anxious  to  know  how  he  can 
have  a  good  dinner  after  the  day's  work  without  having  to 
suffer  for  it.  It  is,  of  course,  a  little  difficult  to  answer  all 
these  questions  in  a  general  manner,  because  the  indi- 
vidual has  to  be  studied  and  modifications  must  be  made 
to  suit  his  requirements,  bearing  in  mind  the  condition  s 
of  his  occupation  and  symptoms. 

One  must  enter  a  special  plea  on  behalf  of  sugar 
and  cheese  as  foods  that  might  weU  be  partaken  of  by 
delicate  persons  more  frequently  than  they  are  at  the 
present  time.  The  consumption  of  considerable  quantities 
of  sugar  for  those  whom  it  does  not  upset  by  any 
sensation  of  sickness  or  nausea,  is  always  followed  by 


214  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

increased  energy.  Sugar  need  not  always  be  eaten  in 
the  crude  form  ;  indeed,  there  are  many  ways  in  which 
it  can  be  taken  pleasantly.  Sugar  in  all  forms  is  a  splen- 
did nerve  food,  is  pleasant  to  take  and  is  easily  carried 
about  in  portable  form. 

Cheese  is  usually  rejected  by  neurasthenic  persons  on 
the  ground  of  its  indigestibility,  but,  as  a  matter  of  fact, 
it  is  digestible  enough  if  eaten  in  the  right  way.  Cheese 
affords  considerable  resistance  to  the  action  of  the  diges- 
tive juices  if  swallowed  in  lumps  ;  if  well  masticated,  so 
that  the  digestive  fluids  can  come  into  thorough  contact 
with  its  constituents,  it  will  give  no  trouble  on  this  account. 
Thus  it  is  that  the  popular  combination  of  bread  and 
cheese,  which  necessarily  requires  a  good  deal  of  chewing, 
is  really  an  ideal  one  from  the  point  of  view  of  the  dietist. 
Furthermore,  cheese  can  be  artificially  rendered  very 
digestible  by  serving  it  as  fine  scrapings  mixed  with  milk 
or  cream,  to  which  a  small  quantity  of  bi-carbonate  of 
soda  has  been  added.  No  doubt  every  good  cook  knows 
this,  a,lthough  unaware  of  the  fact  that  the  bi-carbonate 
greatly  aids  in  the  dissolving  process  of  digestion.  It  is 
worth  noting  that  an  authority  on  the  subject  has  said 
that  one  pound  of  cheese  is  able  to  provide  as  much 
energy  as  three  pounds  of  beef. 

Owing  to  the  fact  that  alcohol  stimulates  flagging 
energies  many  nervous  people  are  inclined  to  resort  to  it 
as  a  medicinal  measure  which  may  tide  them  over  par- 
ticularly depressing  periods.  They  are  inclined  to  forget 
that  the  stimulating  effect  of  the  alcoholic  beverage  will 
inevitably  be  followed  by  a  reaction  which  may  be  even 
more  depressing  than  the  original  feeling  of  lassitude 
which  it  was  sought  to  relieve.  Consequently,  one  may 
lay  it  down  as  the  axiom  that  for  persons  of  neurasthenic 
tendency  alcohol  is  rarely  beneficial — and  is  frequently 
harmful.  The  fact  that  in  a  few  instances  the  habitual 
consumption  of  wine  or  spirits  in  moderate  amounts  is 
not   apparently   harmful   should   not   permit   laxity   in 


DIET  IN  CONVALESCENCE  215 

regard  to  this  rule,  and  alcohol  in  every  form  should  be 
studiously  avoided  by  anyone  whose  nervous  system  is 
inclined  to  give  him  trouble,  unless  specifically  ordered. 
Neurasthenia  is,  indeed,  at  times  responsible  for  in- 
ebriety. The  tired  nervous  system  responds  gaily  to  the 
cheering  cup,  but  when  the  temporary  effect  of  the  stimu- 
lant has  passed,  it  needs  yet  another  stimulus  of  the 
same  kind  to  enable  it  to  continue  its  work  at  an  adequate 
level  of  utility.  In  which  lies  an  obvious  danger.  Here  and 
there  it  may  be  advisable  to  allow  a  certain  daily  quantity 
of  whisky  or  v/ine,  but  that  does  not  in  the  least 
mean  that  it  is  always  essential  to  the  nervous  system. 
Of  course  there  are  various  light  wines  and  beers  that 
can  be  partaken  of  even  by  people  of  nervous  tempera- 
ment without  detriment  to  health,  because  in  these  the 
quantity  of  alcohol  is  so  small  that  the  amount  usually 
taken  can  scarcely  have  any  appreciable  effect  one  way 
or  the  other.  In  any  case,  let  it  be  borne  in  mind  that 
there  are  many  unstable  people  to  whom  even  the  smallest 
percentage  of  alcohol  will  act  as  a  deadly  poison,  leading 
to  excitabihty,  irrational  judgment,  and  subsequent 
slacliness.  It  is  a  well-known  fact  that  many  people  who 
have  had  severe  shocks  such  as  head  injuries  or  sun- 
stroke bear  alcohol  badly,  and  may  be  seized  with  all  the 
symptoms  of  drunkenness  after  drinking  quite  a  small 
quantity. 

The  influence  of  hot  and  cold  baths  on  the  nervous 
system  is  another  matter  of  importance  to  the  convales- 
cent. There  is  a  popular  idea  in  certain  quarters  that  a 
sure  cure  for  a  disordered  nervous  system  is  to  take  an 
ice-cold  bath  first  thing  every  morning  and,  in  conse- 
quence of  this,  there  are  not  a  few  people  who  make  a 
habit  of  further  exhausting  their  none  too  strong  nervous 
systems  by  a  daily  plunge  which  is  entkely  unsuitable 
for  their  strength.  When  anyone  plunges  into  cold 
water  a  series  of  events  occur  in  his  system  which,  if 
completed,  makes  for  health  ;    but  if,  through  any  con- 


216  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

stitutional  weakness,  the  full  response  to  the  bath  be 
not  obtained,  the  result  may  be  very  detrimental  to 
well-being.  This  becomes  clear  if  one  traces  the  effects 
of  sudden  contact  of  cold  water  with  the  skin.  Firstly, 
there  is  certainly  a  shock  to  the  system  in  general,  fol- 
lowed immediately  by  lowering  of  the  circulation  through- 
out the  body,  as  evidenced  by  the  shivering  which  im- 
mediately occurs  ;  this  may  be  called  the  "  stage  of 
depression,"  and  in  the  healthy  bather  should  be  quite 
short,  lasting  not  more  than  half  a  minute  or  so.  The 
second  stage  is  the  all-important  one,  and  depends  on 
what  physiologists  call  "  reaction  of  tissues  "  ;  in  it  the 
full  benefits  of  the  cold  j^lunge  are  experienced,  for  this 
reaction  manifests  itself  by  results  which  are  just  the 
opposite  of  those  of  the  first  period.  In  the  "  stage  of 
reaction  "  the  skin  is  flushed  and  becomes  warm,  the  cir- 
culation is  stimulated,  and  a  general  sense  of  fitness 
and  well-being  pervades  the  body. 

Knowing  these  things,  and  thus  understanding  the 
way  in  which  a  cold  plunge  acts  on  the  system,  anyone 
should  be  able  to  judge  for  himself  the  advisability  of 
indulging  in  this  popular  early  morning  habit.  The 
individual  who  at  all  seasons  and  in  all  weathers  finds 
that  he  "  reacts  "  very  quickly  and  feels  warm  and  re- 
freshed even  whilst  in  the  bath,  can  most  certainly  bathe 
without  fear  of  harming  "  nerves  "  or  constitution.  But 
others  who  find  that  they  shiver  on  stepping  out  of  the 
bath,  or  notice  from  other  evidences,  such  as  blueness  of 
the  hands  and  feet,  or  feeling  of  general  depression,  that 
they  are  not  reacting  properly,  should  at  once  give  up 
the  habit.  Of  course,  there  are  not  a  few  people  who 
"  react  "  thoroughly  throughout  the  summer  months, 
and  yet  have  difficulty  in  getting  warm  after  a  cold 
plunge  on  a  wintry  morning  ;  it  is  probable  that  in  all 
such  cases  the  bath  does  more  harm  than  good  whether 
the  water  is  found  to  be  "too  cold"  for  comfort,  or 
the    "  reaction  "   is    delayed.     This    being    understood, 


DIET  IN  CONVALESCENCE  217 

it  may  at  once  be  said  that,  where  they  can  be 
taken  with  comfort,  cold  morning  baths  are  good  for 
those  whose  nerve-tone  is  low,  or  who  tend  to  suffer 
from  "  nerves  "  in  any  form.  To  those  who  can  stand  it, 
a  bath  which  is  just  a  few  degrees  below  the  average 
temperature  of  the  morning  air  is  certainly  a  powerful 
tonic,  but  it  is  a  great  mistake  for  anyone  to  persist  in 
taking  a  cold  bath  when  he  feels  it  is  an  effort  to  do  so, 
and  when  he  knows  that  his  system  does  not  respond  to 
the  considerable  shock  which  is  given  to  it  in  this  way 
every  morning.  Most  delicate  people  vnR  find  that  they 
will  be  very  much  better  by  substituting  appUcation 
with  a  damp  towel  for  the  actual  bath.  In  the  case  of 
the  rnajority  whose  nerve-energy  is  below  par,  a  really 
cold  bath  further  increases  their  exhaustion,  although  it 
may  appear  to  give  temporary  fillip  to  the  jaded  system. 
But  a  brisk  rub  down  with  a  towel  never  fails  to  invigorate, 
to  warm  and  to  strengthen.  One  has  known  a  good  many 
people  to  make  this  substitute  with  the  very  greatest 
advantage.  In  regard  to  one  peculiar  effect  of  the  morn- 
ing plunge  a  note  of  warning  must  be  given.  There  are 
some  who  are  remarkably  elated  and  stimulated  as  the 
immediate  result  of  their  morning  "  tub  "  no  matter  how 
slack  they  feel  on  getting  out  of  bed,  the  contact  with  the 
stinging  water  brightens  them  at  once  ;  they  splash 
about  joyfuUy  and  often  feel  constrained  to  sing  or 
whistle  lustily  as  they  finish  their  toilet.  But,  alas,  a 
sad  reaction  quickly  overtakes  them,  and  in  half  an  hour 
or  so  the  bright,  invigorated  feehng  has  gone,  and  in  its 
place  has  come  a  sense  of  lassitude  and  fatigue.  This 
sequence  of  events  is  by  no  means  rare  in  persons  of 
nervous  constitution ;  it  is  quite  certain  that  where 
it  occurs  the  cold  bath  does  more  harm  than  good. 
On  the  whole,  it  may  be  said  that  very  hot  baths  are 
certainly  very  bad  for  the  nervous,  and  they  exhaust 
far  more  than  they  strengthen.  Warm  baths,  on  the 
other  hand,  are  sedative  and  as  such  are  useful  to  soothe 


218  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

an  over-tired  system,  especially  when  excessive  physical 
exercise  has  been  the  chief  factor  in  bringmg  about  the 
fatigue. 

Again,  clothes  play  a  more  important  part  in  the  lives 
of  nervous  people  than  is  generally  reahzed.  In  the  first 
place,  many  neurasthenics  feel  the  cold  very  much  ; 
their  skins  are  pale  and  bloodless,  so  that  the  surface  of 
the  body  always  tends  to  feel  colder  than  general  circum- 
stances may  warrant.  Thus,  except  in  the  warmest 
weather,  they  commonly  feel  chiUy  unless  clothed  to  an 
extent  that  the  normal  person  regards  as  unreasonable. 
In  this  country,  where  cold  winds  so  often  prevail,  this 
failure  to  resist  the  cold  is  accentuated  ;  hence,  on  these 
grounds  alone,  the  lot  of  the  neurasthenic  is  an  unhappy 
one.  Not  until  he  can  assimilate  sufficient  nerve-energy 
to  enable  the  circulation  to  be  so  adjusted  that  the  warm 
blood  is  sent  to  the  skin  in  due  proportion,  in  consequence 
of  which  the  body-surface  ceases  to  feel  unduly  cold, 
does  he  become  independent  of  superabundant  clothes. 
People  who  suffer  thus  are  quite  right  to  wear  extra 
clothes  to  keep  them  warm  ;  but  they  are  unwise  to 
put  on  so  much  clothing  that  the  proper  functions  of 
the  skin  are  interfered  with.  It  must  be  remembered 
that  the  body  gives  out  exhalations  through  the  skin, 
and  it  is  most  desirable  for  health's  sake  that  the  air 
immediately  surrounding  each  individual — ^that  is,  be- 
tween skin  and  clothes,  or  between  the  different  layers  of 
clothing — should  be  in  free  communication  with  the 
outside  atmosphere.  Moreover,  the  packing  on  of  heavy 
clothes,  far  from  reducing  the  normal  balance  between 
heat -production  and  heat-loss,  actually  tends  to  pro- 
duce further  chiUing  ;  for  this  reason  that  the  neuras- 
thenic person  who  feels  the  cold  has  lost  the  quick  normal 
reaction  of  the  skin  found  in  healthy  people  by  which  a 
due  supply  of  warm  blood  is  sent  to  it  m  chiUy  weather. 
Now  the  more  he  endeavours  to  warm  the  air  next  the 
skin    the    more    will   the    nervous    mechanism    thereof 


DIET  IN  CONVALESCENCE  219 

shirk  its  task  of  properly  v/arming  it.  Consequently, 
the  more  a  habit  is  made  of  pandermg  to  this  fault  of  the 
skin,  the  worse  will  be  its  behaviour.  Persons  who  rely 
on  many  layers  of  heavy  clothing  to  keep  them  warm 
forget  the  part  played  by  exercise  in  the  natural  main- 
tenance of  body-heat.  Man  in  his  early  days  had  to  rely 
chiefly  on  muscular  exercise  to  keep  him  warm,  and  even 
after  untold  ages  during  which  he  has  been  gradually 
accustoming  himself  to  artificial  methods  of  keeping 
warm  he  is  still  very  dependent  on  the  working  of  his 
muscles  to  keep  up  the  life-heat  of  his  body.  Neuras- 
thenic persons  naturally  shrink  from  taking  much  physi- 
cal exercise  ;  it  exhausts  them  a.nd  makes  them  miser- 
ably tired — but,  unfortunately,  they  usually  go  to  ex- 
tremes and  take  too  much  on  occasion  and  too  little 
habitually.  A  brisk  walk  each  morning  is  very  desirable 
for  those  who  are  strong  enough  to  get  out.  This  stimu- 
lates the  circulation  at  the  outset,  and  brings  about  a 
rise  of  surface-temperature  which  can  afterwards  be 
more  readily  maintained  by  moderate  clothing.  The 
daily  walk  or  walks  can  be  graduated,  according  to  the 
requirements  of  the  individual,  from  a  hundred  yards  or 
so  up  to  a  few  miles. 


CHAPTER  V 

SLEEP  AND   SLEEPLESSNESS 

The  mystery  of  sleep— Effects  on  brain^ — -An  interesting  experiment 
— Ability  to  sleep  at  will — Insomnia — Common  forms — Causes — 
Fear  and  insomnia — Simple  sleep-bringing  devices — The  restful 
mind — Some  maxims. 

WE  spend  a  third  of  our  lives  asleep,  yet  none  has 
discovered  just  what  it  is  that  happens  when 
sleep  comes.  That  it  is  an  affair  of  the  brain  we  all  know. 
Sleep — or  a  state  of  coma — occurs  if  the  brain  be  Jarred, 
or  pressed  upon,  or  poisoned  beyond  a  certain  point. 
Undoubtedly  sleep  results  directly  from  something  which 
temporarily  influences  the  brain  cells — something  which 
is  natural,  rhythmical  and  sure  in  action.  But  mystery 
envelops  that  something.  Perhaps  it  is  a  folding  up  of 
the  little  tentacles  by  v/hich  cell  makes  contact  with  cell  ; 
perhaps  it  is  a  shutting  off  of  the  supply  of  nourishment 
to  certain  nerve-centres,  or  even  a  rise  and  fall  in  the  tide 
of  blood  flowing  through  the  brain.  Who  knows  ?  All 
these  things  have  been  suggested  but  none  proved.  The 
one  thing  we  are  all  agreed  upon  is  that  sleep  is  the 
greater  restorer.  Behind  the  dark  curtain  which  it  so 
mercifuUy  throws  over  human  activities,  Natiu-e  works 
miracles  of  healing.  Time  after  time  when  fighting  for 
a  Hfe  the  doctor  knows  that  victory  will  be  his  if  only 
sleep  will  be  his  ally ;  no  drug,  no  cure,  no  operation  will 
help  so  much  as  a  few  hours'  natural  sleep  in  many  crises 
of  disease. 

As  brain  work  not  only  uses  up  energy,  but  wears  out 
a  certain  amount  of  vital  tissue — a  fact  that  has  been 

220 


SLEEP  AND  SLEEPLESSNESS  221 

proved  by  scientific  experiment — it  follows  that  sleep 
must  lead  to  actual  restoration  of  the  nervous  system. 
There  was  once  a  physician  who  devoted  himself  to 
estimating  small  losses  or  gain  of  weight  in  his  own 
body  under  varying  conditions  of  health  and  work ;  he 
found  that  just  as  there  is  a  small  diminution  of  weight 
after  ordinary  exercise,  so  there  is  after  a  period  of  brain 
work.  Then,  again,  physiologists  have  shown  by  dehcate 
measurements  that  activity  of  the  brain  is  actually 
accompanied  by  a  fractional,  but  measm^able  rise  of 
temperature  ;  the  popular  and  poetic  fancy  of  a  heated 
brain  is  thus,  indeed,  a  scientific  fact.  Conversely  it  is  true 
that  to  cool  one's  brain — another  colloquialism — ^the 
best  thing  to  do  is  to  sleep.  It  is  sufficiently  evident, 
then,  that  in  respect  of  tissue  waste,  loss  of  weight,  and 
heat,  mental  work  has  a  very  definite  effect  on  the 
general  conditions  of  the  body.  Bacon  showed  himself 
once  more  a  shrewd  and  accurate  observer  of  man- 
kind when  he  remarked  that  sleeplessness  threatened 
fife. 

Sometimes  under  pressure  of  work  men  voluntarily  do 
without  sleep  to  finish  an  appointed  task,  and  occasion- 
ally one  comes  across  a  man  of  affairs  or  literary  interest 
who  has  been  able  to  make  a  habit  of  working  until  two 
or  three  o'clock  in  the  morning  or  even  later  without 
impunity,  whilst  commencing  each  day  at  the  same  time 
as  his  fellows.  It  is  very  dangerous  for  the  ordinary  man 
to  make  an  endeavour  to  emulate  these  excej^tional 
powers.  The  irrevocable  breakdown  of  Southey,  who 
sacrificed  sleep  to  write  not  only  poetry,  but  essays  on 
historical  and  general  matters,  may  well  serve  as  a 
warning. 

Nature's  activities  during  sleep  are  well  illustrated  by 
the  rapidity  with  which  an  exceptionally  long  bout  of 
work  wiU  be  compensated  by  a  little  extra  slumber.  In 
emergency  we  may  be  called  upon  to  forfeit  a  night's  rest, 
but  a  sound  sleep  the  next  night  wipes  out  the  balance 


222  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

owing,  and  we  start  again  fresh  and  fit  ;  a  not  uncommon 
experience  once  scientifically  tested  by  an  experiment 
carried  out  in  an  American  University.  In  this  three 
educated  men  were  kept  awake  for  some  ninety  hours — 
representing  a  succession  of  rather  more  than  four  days 
and  three  nights.  After  this  long  vigil  each  felt  quite 
well  after  only  a  few  hours'  more  sleep  than  he  would 
usually  have  had  on  going  to  bed.  It  is  evident  that  the 
willing  victims  of  this  scientific  insomnia  were  in  very 
good  health  to  start  with  ;  had  they  been  neurasthenic 
the  experiment  might  have  led  to  many  bad  nights  and 
inability  to  regain  the  natural  habit  of  sound  sleep.  It  is, 
indeed,  always  dangerous  to  play  tricks  with  one's  rest, 
for  though  one  here  and  there  finds  someone  who  needs 
but  little  sleep — Frederick  the  First  and  Napoleon  are 
said  to  have  been  of  this  order — most  of  us  require  to 
slumber  at  least  eight  hours  if  we  are  to  carry  on  in  health  ; 
a  fact  that  has  been  made  use  of  by  races  excelling  in  the 
invention  of  diabolical  forms  of  torture.  Punished  by 
being  kept  from  sleep — spear-points,  forced  exercise, 
blows  and  noise  all  being  made  to  play  a  part — the  victim 
of  this  abominable  cruelty  loses  sense  of  place  and  time 
and  then  succumbs.  This  same  torment  of  preventing 
sleep  has  also  been  used  in  the  prolonged  interrogation 
of  suspected  criminals  by  relays  of  questioners  carrying 
on  a  requisition  by  day  and  by  night  until  some  sort  of 
confession  is  wrung  from  the  exhausted  prisoner.  Under 
such  circumstances  the  sufferer  is  bound  to  give  all 
kinds  of  abnormal  resi3onses,  and  the  value  of  evidence 
obtained  in  such  a  way  must  always  be  doubtful.  The 
great  war  has  given  us  ma-ny  examples  of  the  wonder- 
ful restorative  powers  of  sleep  to  men  exhausted  by 
exceptional  strain.  Of  these  one  recalls  how  the  old 
British  Army,  exhausted  as  it  was  in  the  great  retreat 
from  Mons,  nevertheless  was  far  from  being  as  knocked 
out  as  the  enemy  probably  supposed.  Fitness  and  train- 
ing told,  the  men  slept  well,  and,  restored  to  strength  in 


SLEEP  AND  SLEEPLESSNESS  223 

a  remarkably  short  time,  tm^ned  on  their  foes  with  all 
their  old  fire  and  beat  them. 

There  are  people  so  constituted  as  to  be  able  to  obtain 
refreshing  sleep  whenever  they  feel  inclined.  In  the 
midst  of  work,  after  a  meal,  or  on  a  railway  journey  they 
can  compose  themselves  and  sleep  soundly  for  a  while, 
awaking  clear  enough  in  head  and  feeling  all  the  better 
for  their  nap.  It  requires  a  temperament  far  more  equ- 
able than  that  enjoyed  by  the  average  person  of  nervous 
predisposition  to  have  such  fortunate  command  of 
Nature's  heaKng  balm.  Possibly  the  small  amount  of 
sleep  required  by  Napoleon,  already  noted,  can  be 
accounted  for  in  part  by  his  ability  of  stopping  work 
and  "  dropping  off  "  into  a  dose  when.ever  he  wished. 
Gladstone  is  said  also  to  have  had  this  power  of  stopping 
the  machinery  of  mental  effort  at  will,  and  to  have  been 
able  to  go  home  and  fall  asleep  at  once  after  having  left 
the  House  of  Commons  in  a  blaze  of  excitement  following 
a  speech  of  his  own.  The  soothing  effects  of  sleep 
on  the  body  generally  are  clearly  seen  in  the  soft 
regular  breathing,  the  relaxation  of  the  body,  and,  if  one 
examines  for  it,  in  the  gentler  beat  of  the  heart  and  the 
steadier  pulse.  Whilst  consciousness  is  lost  or  perhaps 
focussed  elsewhere,  whilst  voluntary  movements  cease, 
and  the  nervous  system  is  eased  of  outward  strain,  the 
automatic  processes,  nevertheless,  still  pursue  their 
normal  course,  and  in  health  the  mechanism  of  the  body 
works  smoothly  and  unchecked.  On  the  contrary,  when 
sleep  is  disturbed  there  is  commonly  a  reflected  dis- 
turbance of  function,  whilst  again  if  there  is  disturbed 
digestion,  for  example,  sleep  is  often  broken. 

Ample  sleep  is  very  necessary  where  inborn  delicacy 
or  nervousness  make  the  individual  dependent  on  restful 
nights  for  the  maintenance  of  those  slender  energies 
which  are  all  they  have  to  face  the  world  with.  But, 
indeed,  few  people  of  nervous  temperament  manage 
to  escape  periods  of  indifferent  sleep.     Digestive   dis- 


224  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

turbances  alone  are  responsible  for  many  restless  nights 
in  neurasthenic  persons.  Again,  whilst  any  emotional 
disturbance  readily  occasions  insomnia  in  some,  there  are 
many  delicate  people  whose  sleep  very  readily  becomes 
impaired,  and  who  consequently  have  to  be  especially 
careful  not  to  permit  any  variation  of  their  daily  routine 
which  experience  has  shown  them  is  likely  to  unsettle  their 
nights.  Where  sleep  is  disturbed  the  disorder  is  either  one 
of  defective  quality  or  deficiency  in  duration.  Some  find 
it  difficult  to  go  to  sleep  in  the  first  instance,  but,  having 
once  lost  consciousness,  rest  comfortably  throughout 
the  night  ;  others  fall  asleep  readily  enough,  but  wake 
in  the  early  morning  hours,  and  then  find  it  difficult  to 
sleep  again.  When  the  rest  is  deficient  in  quality  the 
individual  manages  to  sleep  for  the  greater  part  of  the 
night,  but  suffers  from  a  multitude  of  dreams  and  sensa- 
tions of  semi-consciousness.  He  is  asleep,  yet  he  is  awake. 
Sometimes  he  wakes  in  the  early  morning  hours  with  a 
sense  of  weariness,  and  rouses  himself  out  of  the  trouble- 
some state  of  muddled  dreaminess  which  bothers  him,  with 
the  object  of  making  a  fresh  start.  Sure  enough  he  falls 
off  to  asleep  again  only  to  find  himself  once  more  caught 
in  the  mazes  of  that  mixed  mentaUty  which  so  many 
neurasthenics  know  too  well.  When  the  wakefulness  is 
persistent  or  the  muddled  dreams  prevent  proper  rest 
night  after  night  then  it  is  time  for  some  steps  to  be  taken 
to  improve  this  unhappy  state  of  affairs.  On  the  other 
hand,  those  occasional  periods  of  disturbed  rest  which 
trouble  over-sensitive  people  are  not  necessarily  to  be 
regarded  seriously.  Such  bouts  of  indifferent  rest  should 
never  be  permitted  to  become  the  starting  point  for 
morbid  fears  about  possible  disastrous  consequences. 
Important  as  sleep  is  it  is  nevertheless  true — as  the 
experiment  previously  quoted  shows — that  several  sleep- 
less nights  in  succession  may  be  experienced  without 
danger. 

Several  hours  at  rest  in  bed  in  a  quiet  darkened  room 


SLEEP  AND  SLEEPLESSNESS  225 

sufficiently  relieve  the  periods  of  daily  activity  as  to 
protect  the  nervous  system  from  immediate  disorder  ; 
it  is  possible  to  obtain  sufficient  rest  to  maintain  mental 
health  for  some  time  by  spending  one's  nights  in  a  state 
of  mental  restfulness,  although  sleep  does  not  ensue. 
Nervous  persons  cannot  appreciate  this  point  too  fully, 
for  many  let  their  fears  of  imminent  disaster  work  far 
more  harm  to  them  than  would  ever  be  occasioned 
by  the  loss  of  sleep  about  which  they  worry.  Unfor- 
tunately nothing  tends  to  banish  sleep  so  quickly  as 
nervousness  and  apprehension  about  it.  Far  better  to 
brave  the  discomfort  and  wait  for  the  disturbed  balance 
of  rhythm  between  wakefulness  and  somnolence  to  be 
naturally  restored  than  immediately  to  resort  to  seda- 
tives. When  nights  are  disturbed  people  should  judge 
their  condition  by  the  state  of  their  general  health  and 
not  anticipate  trouble  by  over-estimating  the  importance 
of  the  matter.  When  all  is  said  and  done,  quite  sleepless 
nights  are  rare,  and  even  the  worst  sleepers  usually 
succumb  to  Natm'e's  anaesthetic  in  the  early  hours  of 
the  morning.  In  any  event,  those  who  manage  to  sleep 
for  some  three  hours  or  so  during  the  night  obtain  quite 
enough  to  maintain  strength  for  an  indefinite  period. 
Sleep  soon  after  going  to  bed  may  be  more  restful  and 
natural,  but  if  it  will  not  come  then  we  must  be  grateful 
for  the  rest  obtained  later  on.  On  no  account  let  us 
worry  about  it.  It  is  certainly  not  suggested  that  there  is 
any  advantage  in  such  a  state  of  things,  and  if  it  persists 
the  time  comes  when  the  question  of  doing  something 
to  remedy  it  will  necessarily  arise.  Until  then  patience 
must  be  exercised.  Cases  often  occur  in  which  sleep  has 
become  reduced  to  a  minimum  and  health  suffers  com- 
paratively little.  On  the  other  hand,  it  must  be  remem- 
bered that  people  often  sleep  for  longer  than  they  know, 
it  being  difficult  to  estimate  accurately  how  long  one  has 
slept.  Quite  honest  people  report  they  have  scarcely 
slept  at  aU,  when  the  evidence  of  observers — ^relatives  or 


226  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

nurses — ^is  quite  to  the  contrary.  Again,  invalids  will  say 
that  they  hear  the  clock  strike  every  hour  throughout 
the  night,  thus  seemingly  proving  a  case  for  serious 
insomnia.  Nevertheless,  one  knows  that  light  sleepers 
sometimes  get  into  the  habit  of  waking  sufficiently  to 
hear  the  clock  strike  and  immediately  dropping  ofi  to 
sleep  again.  A  habit  of  this  kind  is  by  no  means  difficult 
to  estabUsh,  and,  where  fear  disturbs  judgment  as  well  as 
sleep,  totally  erroneous  accounts  may  be  given  by  the  best 
intentioned  people. 

There  are  again  some  who  whilst  sleeping  badly  at 
night,  are  able  to  get  an  hour  or  two's  sleep  in  the  after- 
noon or  late  evening  ;  this  is  all  to  the  good,  although 
they  are  wise  to  make  every  effort  to  get  all  their  sleep 
at  the  right  time  if  possible,  so  as  to  be  able  to  forget  all 
about  the  question  of  having  a  good  night's  rest.  Assur- 
ance as  to  the  relative  significance  of  occasional  or  even 
periodic  disturbed  nights  is  always  helpful  and  enables 
sufferers  to  get  rid  of  their  morbid  and  groundless  anxie- 
ties. Several  instances  come  to  mind  of  people  who  have 
established  a  periodic  phase  of  wakefulness.  That  is  to 
say,  that  they  have  got  into  the  habit  of  a  bad  night  at 
fairly  regular  intervals.  Two  good  nights  followed  by  a 
poor  one  is  a  not  uncommon  sequence.  Where  this  is  so 
it  is  often  found  that  a  definite  routine  has  been  deve- 
loped. Great  preparations  are  made  for  getting  through 
the  night.  Not  only  the  victim  of  all  this  morbid  self 
suggestion  is  concerned,  but  the  whole  household  knows 
that  it  is  so-and-so's  "  bad  night."  Books,  food,  lights, 
apparatus  for  making  tea  or  cocoa  are  all  arranged  for. 
Going  to  bed  without  the  least  thought  of  sleeping — 
under  the  influence  of  a  suggestion  that  sleep  is  not 
coming — with  all  the  paraphernalia  just  indicated — 
and  with  every  one  else  in  the  house  dominated  with  the 
same  fear-thought,  is  it  to  be  expected  that  the  periodic 
sleeplessness  will  be  easily  remedied  ? 

A  word  as  to  simple  means  of  inducing  sleep,  remem- 


SLEEP  AND  SLEEPLESSNESS  227 

bering  that  the  more  we  seek  it  the  more  elusive  it  may 
be,  whilst  the  less  we  bother  about  it  the  more  quickly  it 
win  come.  To  Ke  dowii  with  the  expressed  intention  of 
forcing  oneself  to  sleep  is  only  too  likely  to  be  followed 
by  the  reverse  effect.  Similarly,  the  old-fashioned  ways 
of  seeking  sleep  by  such  devices  as  counting  imaginary 
sheep  going  over  a  stile  ;  counting  up  to  ten  thousand, 
or  counting  backwards ;  reciting  things  mentally  back- 
wards or  forwards,  and  so  forth,  are  aU  open  to  the  same 
criticism  that  they  direct  attention  too  strongly  to  the 
question  of  going  to  sleep.  At  the  end  of  the  mental  task, 
when  innumerable  sheep  have  been  watched  over  the 
stile,  or  counting  has  soared  into  the  thousands,  should 
sleep  not  have  closed  the  exercise  an  anticlimax  will  have 
been  reached,  and  the  last  state  of  the  sufferer  be  worse 
than  the  first.  Far  better  is  it  to  take  a  journey  in 
thought,  recalling  various  scenes  of  some  excursion  that 
has  been  enjoyed  in  times  past — noting  the  varying 
phases  of  experience,  the  towns  visited,  the  scenery 
passed  by,  the  people  met.  Alternatively,  a  tour  can  be 
planned  by  car  or  on  foot  and  the  pleasures  of  the  road 
anticipated  stage  by  stage.  One  is,  of  course,  in  some- 
thing of  a  quandary  when  wakeful  people  teU  us  that 
nightly  they  have  arrived  at  the  end  of  many  journeys, 
but  never  yet  found  themselves  in  the  Land  of  Nod  ! 

In  any  case,  it  is  essential  to  assume  as  comfortable  a 
position  as  possible  in  bed,  carefully  relaxing  the  whole 
body.  A  relaxed  restful  body  mirrors  a  relaxed  and 
peaceful  mind.  Let  feet,  legs,  and  arms  be  restfully 
relaxed  so  that  no  portion  of  the  body  is  strained.  Get 
the  tightness  out  of  the  muscles  and  feel  the  restfulness 
that  comes  when  tension  is  undone.  Relaxation  having 
been  secured,  the  matter  of  sleep  should  be  dismissed  and 
the  thought  occupied  with  any  pleasant  subject  that 
occurs.  The  journey  may  find  a  place  here,  but  it  wiU 
not  help  if  the  suggestion — "  At  the  end  of  the  journey  I 
shall  sleep  " — is  to  the  fore.    These  voyages  of  conveni- 


228  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

ence  should  have  no  goal.  Certainly  professional  or 
business  problems  should  be  excluded  and  opportunity 
taken  for  letting  thoughts  dwell  on  the  spiritual  values 
of  life  ;  it  is  clear  that  those  who  have  spiritual  interests, 
and  who  are  accustomed  to  rely  on  spiritual  meditation 
or  prayer,  have  an  advantage  over  those  whose  lives  are 
differently  ordered.  To  know  that  through  the  veil  of 
appearances  the  true  world  of  love,  beauty,  and  harmony 
is  to  be  seen  however  dimly  ;  to  hold  fast  to  the  thought 
that  in  all  times  and  through  all  distresses  Man  as  Spirit 
is  unconquered  and  unconquerable  ;  to  feel  assurance 
of  Divine  Love,  is  to  have  a  sure  protection  from  insomnia's 
terrors.  Fear  conscious  or  subconscious  in  one  guise  or 
another  is  at  the  root  of  all  nervous  sleeplessness.  To 
know  God  is  to  banish  fear.  "  I  will  both  lay  me  down  in 
peace,  and  sleep  :  for  thou.  Lord,  only  makest  me  dwell 
in  safety,"  sang  the  Psalmist.  That  is  the  attitude  of 
calm  trust  that  dispels  fears,  quiets  turbulent  emotion, 
soothes  the  weary  thought  and  brings  sleep. 

Maxims  for  the  sleepless — The  following  general  axioms 
may  well  be  noted  : 

1.  One  hour  of  sleep  before  one  o'clock  in  the  morning 
is  better  than  three  hours  taken  later  on. 

2.  To  stay  up  after  eleven  o'clock  at  night  is  to  expend 
nervous  energy  that  will  probably  be  needed  on  the 
morrow. 

3.  To  go  to  bed  early  one  night  and  late  the  next,  with- 
out any  method,  rhyme,  or  reason,  is  to  tempt  the  mind  to 
form  bad  habits  in  regard  to  sleep,  and  so  favour  the  onset 
of  a  sleeplessness  that  may  be  very  difficult  to  get  rid  of. 

4.  Even  when  constantly  wakeful  sedative  drugs  should 
be  the  very  last  thing  thought  of. 

5.  One  hour  of  natural  sleep  is  at  any  time  worth 
several  hours  of  unconsciousness  produced  by  drugs. 

6.  To  sleep  with  the  aid  of  drugs  is  merely  to  avoid  the 
main  issue,  and  the  latter,  however,  may  be  helpful, 
if  continued. 


SLEEP  AND  SLEEPLESSNESS  229 

7.  To  go  to  bed  with  the  mind  full  of  worrying  thoughts 
or  business  matters  is  consciously  to  make  an  attempt 
to  thwart  the  onset  of  sleep,  and  consequently  a  very 
bad  habit.  When  the  brain  is  very  active  it  is  well  to 
spend  half  an  hour  reading  poetry  or  sedative  literature 
before  seeking  sleep. 

8.  Regula,rity  in  the  time  of  retiring,  and  regularity  in 
the  number  of  hours  spent  in  bed,  make  for  the  preserva- 
tion of  energy. 

9.  The  habit  of  taking  extra  naps  after  once  waking 
in  the  morning  is  a  bad  one  at  any  time,  and  specially 
tends  to  produce  a  feeling  of  lassitude. 

10.  Such  simple  things  as  having  a  well- ventilated 
bedroom,  not  piling  up  too  many  bed-clothes,  having  a 
hot-water  bottle  if  cold,  keeping  a  few  biscuits,  or  a  little 
cocoa  in  a  vacuum  flask  by  the  bedside  are  more  helpful 
than  medicines  for  securing  sleep. 

11.  As  a  rule,  brain-workers  should  have  seven  hours' — 
and  preferably  eight  hours' — sleep  each  night. 


CHAPTER  VI 
EEST  AND   KECREATION 

Rest  apart  from  sleep — The  rest  hour — Ways  of  seeimng  rest — Hus- 
banding resources — Unhealthy  restlessness — The  proper  ordering 
of  spare  time — Over-exercise — Common-sense  and  nerve  energy — 
Rest  and  over-work — Recreation — Walking — Cycling— Golfing — 
Change  of  air — Sea  voyages — Smoking. 

IT  is  possible  for  delicate  people  to  obtain  a  great  deal 
of  recuperative  and  properly  regulated  rest,  apart 
from  actual  sleep  ;  although  the  more  nervous  or  excit- 
able anyone  is  the  less  he  is  capable  of  obtaining  ample 
repose.  Clearly  rest  may  be  obtained  simply  by  lying 
down  in  a  quiet  room,  or  lounging  in  a  comfortable  chair, 
but  more  than  this  it  is  rest  of  thought  and  freedom  from 
strain  that  is  the  important  thing.  Every  one  who  suffers 
from  nervous  symptoms  should  make  a  rule  of  having  a 
time  of  retirement  during  the  day,  an  hour  that  should 
be  given  up  to  drowsiness  and  quiet  meditation.  During 
this  time  nothing  that  is  worrying  or  too  absorbing 
should  be  done,  nor  physical  exercise  taken.  In  such  a 
"  rest-hour  "  all  muscles  should  be  relaxed  and  the  work- 
ings of  the  mind  and  body  brought  to  their  lowest  ebb. 
Thus  considerable  recuperation  can  be  obtained  which 
helps  to  preserve  precious  nerve-energy.  Many  people 
steadily  squander  their  nerve-force  throughout  the  day 
without  a  pause  ;  they  say  that  it  is  impossible  to  get  a 
"  rest-hour  "  in  the  course  of  the  day.  They  are  too 
busy,  they  have  so  many  social  engagements  or  too  many 
calls  upon  their  time  to  indulge  in  such  a  luxury.  But 
if  they  will  only  apportion  their  programme  for  the  day 

230 


REST  AND  RECREATION  231 

in  the  right  manner,  and  with  a  calm  regard  for  the  actual 
necessities  of  life,  they  will  quite  easily  be  able  to  find 
one  hour  to  set  aside  for  rest  and  solitude.  Is  it  not  a  fact 
that  the  busiest  people  often  have  the  most  time  ?  Their 
business-like  habits  are  orderly,  and  orderliness  makes  for 
leisure.  Solitude  is  a  desirable  attribute  of  the  rest-hour, 
for  nervous  peoeple  when  moving  about  in  society  and 
amongst  friends — or  even  about  the  streets — seem  readily 
to  lose  theii'  vitality,  and  retirement  from  their  fellows 
frees  them  from  this  outside  drain  for  the  time  being. 
Some  highly  strung  individuals  become  exhausted  after 
merely  passing  through  a  crowd  of  people,  and  these 
ought  to  be  careful  to  take  their  "  rest-hour  "  regularly 
every  day  of  their  lives. 

Rest  can  be  secured  in  many  other  ways  ;  rest  in  the 
little  things  which  tend  to  strain  the  nerves.  It  is, 
indeed,  the  little  habits  and  actions  of  life  which  are 
largely  responsible  for  reducing  the  nerve-energy  of  the 
delicate  ;  they  represent  far  more  perhaps  than  the  reaUy 
big  tasks,  which  after  aU  are  not  so  very  common  in  the 
life  of  the  average  individual.  What  is  meant  by  this  is 
that  there  are  many  people  who  carry  on  their  conversa- 
tions, and  perform  all  their  actions  with  a  superfluous 
expenditure  of  energy  which  is  inevitably  exhausting 
their  reserve  stores  of  nerve-force — although  they  seem 
quite  unconscious  of  this  obvious  fact.  They  put  a 
thousand  times  as  much  vitality  into  the  performance  of 
a  simple  action,  such  as  writing  a  letter,  or  catching  a 
train,  or  speaking  to  somebody  on  the  telephone,  or 
ordering  the  dinner,  as  does  the  ordinary  phlegmatic 
person  who  knows  not  what  nerves  are.  It  is  here  that 
the  regaining  of  lost  control  is  so  very  helpful,  and  when 
increased  control  has  been  secured  the  first  and  best  way 
the  nervous  individual  can  put  it  to  use  is  in  exercising 
strict  supervision  over  the  daily  expenditure  of  nerve- 
energy  in  small  coin.  In  conversation,  in  going  about 
the  house,  in  work  at  the  office,  or  in  walking  along  the 


232  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

street,  increasing  control  should  be  obtained  over  the 
excessive  flow  of  nerve -energy  which  invariably  charac- 
terises highly-strung  people.  If  such  control  be  carefully 
built  up  and  wisely  exercised,  the  conservation  and  pre- 
servation of  nerve-force  can  be  carried  out  to  a  remark- 
able extent  with  the  greatest  benefits  to  health,  work, 
and  life  in  general.  The  preservation  of  nerve -force  in 
the  little  things  of  life  makes  a  great  difference  to  the 
ultimate  happiness  of  nervous  people.  We  all  know 
people  who  have  no  method,  no  system,  no  definite  out- 
look upon  life  ;  if  they  want  to  write  a  letter  they  have 
to  collect  their  material  from  aU  parts  of  the  house,  they 
find  they  have  to  get  fresh  paper,  or  they  have  run  out  of 
ink,  or  they  have  no  stamps,  or  they  have  lost  the  address 
of  the  person  to  whom  they  wish  to  write,  or  a  dozen  and 
one  other  things  crop  up  which  prevent  the  simple,  easy 
carrying  out  of  a  simple  normal  act.  Such  people  tire 
themselves  out  in  simple  things  of  this  kind.  On  the 
other  hand,  by  exercismg  seK-control  they  can  so  get  the 
better  of  their  excitable  nerves,  that  they  can  form 
methodical  habits  which  will  prevent  all  this  lamentable 
waste  of  nerve-energy.  The  cultivation  of  muscle-control, 
control  of  the  expression,  of  the  habit  of  decision,  and 
of  the  habit  of  taking  things  easUy,  is  of  the  very  greatest 
value  to  anyone  who  suffers  from  nervous  excitability. 
Overhaste,  want  of  method,  indecision,  are  the  enemies 
of  every  sensitive  and  highly  responsive  person. 

The  proper  ordering  of  spare  time  is  a  matter  of  con- 
siderable importance  to  those  whose  nerve  energies  are 
miduly  limited  as  it  is  to  those  whose  tendency  is  to  turn 
their  thought  inward  and  dwell  upon  depressing  things. 
For  both  the  consistent  pm^suit  of  the  right  relaxation 
means  far  more  than  to  the  ordinary  robust  individual. 
Paradoxically  enough,  many  delicate  people  take  far  too 
much  active  exercise,  and  through  this  further  deplete 
their  slender  stores  of  strength.  There  is  no  greater 
fallacy  than  to  suppose  that  hard  work  out  of  doors  wiU 


REST  AND  RECREATION  233 

relieve  nerve  strain.  No  one  can  have  too  much  fresh  air, 
or,  in  this  climate  too  much  sunshine,  but  benefits  of  both 
these  can  be  for  many  far  better  obtained  by  resting  or 
sleeping  out  of  doors  than  by  over-activity  when  vitahty 
is  low.  It  is  not  at  aU  uncommon  for  a  breakdown  to  be 
finally  precipitated  by  the  mistaken  attempts  of  the 
sufferer  to  regain  nerve  strength  by  severe  exercise. 
From  the  physical  point  of  view  the  energies  of  the  body 
are  drawn  from  a  common  source,  namely,  the  air  and 
food  taken  in.  Where  a  man  works  with  his  muscles,  his 
brain,  or  other  organs  there  is  only  a  certain  amount  of 
energy  available  for  him  at  any  given  moment.  In  the 
ordinary  course  of  daily  Hfe  the  common  stock  of  vitaUty 
is  being  continually  drawn  upon  for  the  requirements  of 
digestion,  absorption  of  food,  and  excretion  of  waste 
matters.  The  human  body  is  a  great  factory  in  which 
profound  chemical  processes  are  always  being  carried 
out  ;  whilst  for  their  complete  maintenance  a  multitude 
of  physical  changes  for  the  most  part  consisting  in  muscu- 
lar contractions — of  heart,  stomach,  intestines,  Hmbs, 
and  a  host  of  other  muscles — are  being  performed.  In 
addition  to  this  the  system  has  to  supply  on  demand 
energy  for  extra  muscular  work  or  brain  work.  Accus- 
tomed to  its  routine  demands  the  body  fulfils  these 
requirements  according  to  the  habit  of  the  individual,  but 
it  is  only  under  exceptional  circumstances  of  health  and 
vigour  that  all  these  requirements  can  be  fulfilled  at  a 
high  level  at  the  same  time.  As  has  been  noted  already, 
brain  work  uses  up  a  great  deal  of  energy  being  accom- 
panied by  considerable  physical  and  chemical  changes. 
Wastage  due  to  use  of  the  brain  requires  making  up. 
Just  as  does  wastage  from  the  use  of  the  muscle.  It 
amounts  to  this,  then,  that  where  one  goes  for  a  long  walk, 
writes  an  article,  or  digests  a  heavy  meal,  there  is  wastage 
in  the  body  and  consumption  of  energy  which  have  to  be 
made  good.  The  athlete  has  his  demands  for  energy 
satisfied  by  a  habitual  and  automatic  regulation  of  energy 


234  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

distribution  which  meets  his  requirements  ;  similarly, 
the  brain  worker  or  the  gourmand.  But  it  goes  hard  with 
either  if  he  should  suddenly  change  his  mode  of  living, 
substituting  mental  for  physical  exercise  or  sacrificing 
both  to  the  pleasures  of  the  table  to  which  he  has  hitherto 
been  a  stranger.  The  average  individual  avoids  trouble 
by  making  varying  use  of  the  reserves  of  energy  present 
in  normal  health.  Should  he  be  indiscreet  in  exercise, 
brain  work,  or  diet  he  makes  up  for  it  by  a  rest  or 
short  "  cure  "  which  enables  an  adjustment  to  be  effected 
in  his  favour.  Not  so  with  those  v»^hose  nervous  systems 
are  delicate  and  whose  balance  at  the  bank  of  energy  is 
customarily  low.  They  are  always  in  danger  of  over- 
drawing, and  an  overdraft  means  a  dangerous  expendi- 
ture of  capital.  In  neurasthenia  reserves  quickly  become 
depleted,  and  consequently  the  use  of  further  vital  energy 
in  unwise  physical  activities  is  not  only  to  prevent  that 
restoration  of  wastage  which  the  nervous  system  so 
urgently  requires,  but  actually  to  increase  the  overdraft. 
Time  after  time  one  finds  a  condition  of  serious  debility 
brought  about  by  misunderstanding  of  the  fact  that  the 
body  has  only  a  certain  amount  of  income  and  reserve 
in  the  matter  of  vitality,  a^nd,  particularly  when  the 
balances  are  low,  cannot  supply  persistent  demands  for 
all  quarters.  True  it  is  that  change  of  occupation  and 
fresh  mental  atmosphere  is  good  for  people  suffering 
from  overstrain,  but  it  is  equally  true,  and  of  even  greater 
importance,  that  rest,  not  activity,  is  the  rule  in  nervous 
exhaustion.  The  place  for  the  overworked  man  who 
has  become  neurasthenic  is  not  the  golf  links,  tennis 
courts,  the  road  or  the  river,  but  bed.  It  follows,  then, 
that  those  who  whilst  in  health  know  from  experience 
that  their  nerve-strength  is  comparatively  poor  should 
be  equally  careful  to  avoid  indulgence  in  recreation  that 
will  certainly  make  serious  demands  upon  their  vitality. 

These  considerations  from  the  physical  point  of  view 
must  be  taken  into  account  with  the  necessity  of  securing 


REST  AND  RECREATION  235 

absorbing  interests  for  those  of  introspective  turn  of  mind. 
Whilst  recreation  must  be  taken  in  such  a  way  as  not 
further  to  deplete  strength,  yet  occupation  apart  from 
work  is  a  paramount  necessity  to  everyone  of  nervous 
tendency.  In  a  word,  recreation  is  useful  and  important 
to  those  Hable  to  nervous  trouble,  but  a  hobby  is  an  urgent 
necessity.  It  may,  then,  be  well  to  give  a  little  thought 
to  the  advantages  and  disadvantages  of  various  sports 
and  pastimes  in  special  relation  to  the  problem  of  nervous 
breakdown. 

Walking  is  splendid  for  neurasthenic  people,  but  it 
must  be  graduated  intelligently.  To  be  health-giving 
walks  should  not  be  aimless  ;  they  should  be  taken  on 
definite  plan  and  with  an  object.  A  walk  that  is  taken 
for  a  certain  distance,  or  for  a  certain  time,  just  because 
the  doctor  advises  it,  is  not  going  to  be  worth  anything, 
and  if  it  bores  to  the  invahd  may  do  more  harm  than 
good.  But  where  a  walker  can  evince  an  interest  in 
places  visited  or  make  a  hobby  of  noting  various  features 
of  Nature,  walks  are  always  beneficial.  Always  care 
should  be  taken  not  to  take  too  long  walks,  but  particu- 
larly when  convalescence  is  being  estabhshed  after  a 
period  of  considerable  exhaustion.  Only  too  often  one 
sees  good  work  spoilt  and  a  relapse  brought  about  through 
neglect  of  this  simple  precaution.  After  some  weeks  of 
quiet  routine  invalids  find  themselves  with  a  new  sense 
of  buoyancy  and  health  which  they  want  to  make  the 
best  of,  and  in  their  delight  do  not  spare  themselves. 
One  need  scarcely  say  that  sympathetic  and  bright 
companionship  make  for  the  success  of  walking  in 
town  or  country.  Indeed,  depressed  or  introspective 
persons  should  avoid  lonely  walks.  All  outdoor  games 
and  pastimes  are  helpful  when  undertaken  with  due 
regard  to  considerations  already  noted.  Cycling  may 
be  made  very  helpful  if  common  sense  governs  the 
use  of  the  bicycle,  but  must  be  avoided  where  ready 
exhaustion  is  already  troublesome.     As  with  cycling  and 


236  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

with  the  same  reservations  one  finds  that  riding  is 
extremely  beneficial  to  a  large  number  of  people  whose 
nerves  tend  to  be  disordered.  Golf  is  popularly  supposed 
to  be  a  splendid  recreation  for  the  nervous,  and  so  it  is  for 
those  who  can  go  round  the  links  without  undue  anxiety  ; 
but  it  is  equally  certain  that  the  golfer  who  worries  over  the 
game  loses  more  than  he  gains  from  the  point  of  view  of 
health.  To  be  in  a  state  of  tension  all  the  way  through 
the  green  ;  to  worry  over  every  stroke  and  round  each 
hole  is  only  to  harass  the  nervous  system.  Hence,  where 
natural  excitability  makes  it  difficult  for  a  course  to  be 
negotiated  without  mental  discomfort  goK  should  be 
given  up  for  a  time.  Among  lighter  recreations,  the 
development  of  carpentering,  wood-carving,  modelling, 
book-binding,  painting,  drawing,  and  so  forth  are  to  be 
encouraged.  Hobbies  that  occupy  both  hands  and  brain 
are  by  far  the  most  valuable.  Music,  typewriting,  the 
microscope,  collection  and  arrangement  of  natural  objects 
may  be  all  employed  in  systematic  nerve-hygiene. 

There  is  a  popular  idea  that  the  sea  is  a  sure  remedy 
for  nervous  fatigue  or  irritability,  but,  indeed,  the  seaside 
is  by  no  means  always  the  best  place  when  nerves  are 
troublesome.  Bracing  air  often  tends  to  aggravate 
sleeplessness,  indigestion,  headache,  and  other  common 
symptoms  of  the  neurasthenic  state.  Certainly  where 
poor  health  is  directly  associated  with  a  short  spell  of 
overwork,  a  journey  to  the  seaside  often  does  good  and 
tones  up  the  system  generally.  But  as  a  general  rule, 
neurasthenic  persons  should  not  go  to  the  sea  without  due 
consideration  of  individual  circumstances.  It  is  a  com- 
mon mistake  of  people  who  need  rest  to  go  to  places  well 
known  for  their  social  advantages  and  excitements  in  the 
hope  of  distracting  their  thoughts.  A  "  rest  "  under 
such  circumstances  becomes  a  farce,  for  at  fashionable 
seaside  resorts  the  regularity  of  daily  life  and  the  quiet 
surroundings  that  are  necessary  for  those  suffering  from 
nerve-exhaustion  are  difficult  to  obtain.    The  most  suit- 


EEST  AND  RECREATION  237 

able  conditions  for  recovery  from  neurasthenia  and  its 
congeners  are  to  be  found  inland  ;  particularly  in  well- 
wooded  districts  where  there  are  hills  to  protect  from 
cold  and  irritating  winds,  and  trees  to  lend  their  soothing 
influence.  There  is  balm  and  healing  in  old  English 
gardens,  fields  and  woods  for  those  of  nervous  tempera- 
ment. Londoners  and  other  town-dwellers  in  this  land  are 
fortunate  in  that  beautiful  country  with  quiet  and  helpful 
natural  surroundings  can  be  obtained  with  little  trouble. 

Health  is  often  sought  through  a  sea  vovage  ;  often, 
indeed,  with  lamentable  consequences.  When  possible 
strength  should  be  restored  under  the  conditions  in 
which  the  life  of  the  patient  has  to  be  led.  The  less 
interruption  of  daily  life  and  work  the  better  for  all 
concerned.  One  may  well  hesitate  to  send  the  victim 
of  a  nervous  breakdown  into  strange  countries,  where 
he  will  have  to  eat  food  that  is  foreign  to  his  digestion, 
keep  all  sorts  of  irregular  hours  that  are  bad  for  him, 
and  be  harassed  by  the  excitement  of  meeting  new  people 
and  seeing  strange  sights.  To  the  great  majority  of 
persons  the  question  of  leaving  their  work  for  a  long 
period,  as  well  as  the  expense  involved  by  long  voyages, 
is  a  matter  for  very  grave  consideration.  It  is  of  little 
value  to  tell  a  man  whose  nerves  are  seriously  out  of 
order  through  over-anxiety  and  worry  to  go  away  to 
South  Africa,  or  the  West  Indies,  or  to  Timbuctoo, 
when  to  do  this  he  would  have  to  leave  affairs  which 
probably  need  his  constant  attention.  To  give  up  work 
for  a  time  is  bad  enough,  but  to  be  thrown  right  out  of 
touch  with  home  interests,  desirable  on  occasion,  is 
commonly  very  disadvantageous  to  health.  On  the  con- 
trary, rest  in  the  country  can  often  be  taken  without 
seriously  jeopardising  prospects. 

Although  smoking  is  so  extremely  common  in  aU  grades 
of  society  no  general  conclusive  opinion  ever  seems  to 
have  been  arrived  at  about  alleged  injurious  effects  of 
this  habit.    Medical  men  differ  on  this  point  so  far  as  con- 


238  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

cerns  moderate  indulgence,  although  they  all  agree  that 
excess  is  distinctly  injurious  to  health.  The  fact  is, 
individuals  vary  so  remarkably  in  their  susceptibilities 
to  tobacco  that  no  general  rule  can  be  framed  as  to  what 
is  moderation  and  what  is  excess.  Consequently,  those 
who  happen  to  have  come  across  some  instances  in  which 
smoking  appears  certainly  to  have  impaired  health  are 
inclined  to  condemn  the  habit,  whilst  ardent  smokers 
retort  by  bringing  forward  some  nonagenarian  who  has 
thrived  on  tobacco  throughout  his  long  life.  As  a  matter 
of  fact,  adverse  criticism  of  one  of  our  most  popular 
habits  seems  scarcely  to  be  supported  by  the  results  one 
sees  in  everyday  life,  for  apart  from  a  few  susceptible 
individuals  the  great  majority  of  fairly  heavy  smokers 
do  not  appear  to  be  on  the  way  to  physical  ruin,  nor  does 
expert  examination  contradict  this  impression.  On  the 
other  hand,  it  would  be  foolish  to  say  tobacco  is  always 
quite  harmless,  as  every  physician  has  before  him  from 
time  to  time  objective  evidences  of  the  disturbances  of 
health  to  which  smoking  may  lead.  Whatever  can  be 
said,  nicotine  remains  a  deadly  poison,  although  it  occurs 
in  very  small  quantities  in  the  actual  smoke  inhaled. 
With  those  who  are  particularly  susceptible  to  nicotine 
poisoning,  even  the  minute  particles  absorbed  may  exercise 
serious  effects  on  heart  and  nerves  ;  indeed,  the  nerve- 
poisoning  is  the  chief  factor,  because  a  considerable 
proportion  of  the  symptoms  due  to  "tobacco-heart  "  are 
unquestionably  due  to  derangement  of  nerve -balance. 
Common  symptoms  due  to  tobacco  poisoning  are  trembling 
hands,  tremors  of  the  lips  on  speaking,  staggering  of  gait, 
giddiness,  and  neuralgic  pains  through  the  head.  Con- 
sequently, whilst  the  majority  of  moderate  smokers  are 
very  unlikely  to  be  injured  by  the  tobacco-habit,  there 
are  certainly  some  who  ought  not  to  smoke.  Obviously 
if  anyone  is  so  susceptible  to  tobacco  poisoning  that  very 
slight  indulgence  in  smoking  produces  giddiness,  or 
palpitation,  he  had  best  be  warned  in  time  and  give  up 


REST  AND  RECREATION  239 

the  habit  altogether.    If  he  does  not  he  will  be  liable  to 
the  more  serious  results  of  nicotine  intoxication. 

Undoubtedly  the  risk  of  nicotine  poisoning  varies  with 
the  mode  of  indulgence.  Thus  the  habit  of  inhaling 
smoke  right  down  into  the  lungs  is  much  more  hkely  to 
lead  to  iU  effects  than  the  simpler  methods  of  just  draw- 
ing it  into  the  mouth.  Again,  there  are  important 
differences  between  pipe,  cigar,  or  cigarette  ;  whilst 
there  are  considerable  variations  owing  to  individual 
reaction.  It  may  be  taken  as  a  general  rule  that  a  pipe 
is  least  harmful,  owing  to  the  fact  that  condensation 
occurs  in  the  stem  and  thus  prevents  a  good  proportion 
of  the  bi-products  from  reaching  the  mouth  ;  on  the 
other  hand,  a  cigar  is  most  likely  to  cause  injurious  effects 
owing  to  the  fact  that  it  most  readily  conveys  moisture 
laden  with  nicotine  and  other  products  into  the  mouth. 
This  theoretical  consideration  is  supported  by  the  practi- 
cal observation  that  excessive  cigar  smoking  certainly 
is  the  most  injurious  of  all  three  ways  of  consuming 
tobacco.  Necessarily,  it  is  particularly  injurious  to 
smoke  right  down  to  the  end  of  the  cigar -stump,  or  to  hold 
it  for  long  in  the  mouth.  The  friendly  cigarette  occupies 
a  middle  place  as  being  distinctly  less  harmful  than  a 
cigar,  and  possibly  more  likely  to  lead  to  poisoning  than 
a  pipe.  It  follows,  then,  that  nervous  people  need  not  be 
forbidden  to  smoke  where  they  do  not  exhibit  signs 
of  special  susceptibility  to  tobacco,  but  as  we  know  that 
nicotine  is  liable  to  "go  for  "  the  nerves,  one  is  natur- 
ally more  careful  in  watching  the  effects  of  smoldng  in 
neurasthenic  individuals  than  in  others. 


CHAPTER  VII 

CHILDHOOD   AND   YOUTH 

Child  father  to  the  man— Plasticity  of  early  life — ^The  nervous  tempera- 
ment in  childhood — Childhood  fears — Night  terrors — Enuresis 
nocturna — Hygiene  of  children's  nerves — ^Diet  in  childhood — 
Mental  hygiene  in  the  nursery — Morbid  sensitiveness — Powers  for 
work  and  play— Dangers  of  over-strain — A  reasonable  programme 
— Sensitiveness  of  early  life — Youth — Critical  period  of  adolescence 
— Its  characteristics  and  dangers — The  psychology  of  young  men 
and  maids. 

IT  has  been  well  said  that  the  child  is  father  to  the  man. 
Certainly  careful  inquiry  into  the  life  history  of 
sufferers  from  nervous  disorders  very  often  reveals  the 
fact  that  from  earliest  years  there  have  been  manifesta- 
tions of  instability.  The  pity  of  it  is  that  these  warnings 
so  often  have  not  been  recognized,  or  if  noted  have  been 
disregarded.  Prevention  as  much  as  cure  is  one  of  the 
great  aims  of  medical  science  to-day,  and  in  the  due 
recognition  and  firm  handling  of  the  early  signs  of  un- 
steadiness are  to  be  found  reliable  means  of  preventing 
subsequent  disaster.  By  training  the  weakly  nervous 
system  to  bear  more  and  more  easily  the  burden  of  life, 
and  by  educating  the  will  so  as  to  develop  its  fullest 
powers  of  self-control,  much  can  be  done  to  enable  those 
who  would  otherwise  suffer  breakdown  to  fight  their  way 
successfully  through  the  battle  of  life.  The  plasticity  of 
early  life  is  still  not  sufficiently  realized  by  parents  and 
educational  authorities. 

The  appearance  of  any  of  those  signs  by  which  the 
nervous  temperament  invariably  betrays  itself  in  child- 
hood should  be  taken  as  an  urgent  call  for  special  care. 
Such  early  evidences  include  St.  Vitus'  dance  (chorea), 

240 


CHILDHOOD  AND  YOUTH  241 

or  other  persistent  twitching  movements,  convulsions, 
vacant  expression,  drooping  head,  dropping  of  hands 
when  arms  are  extended,  slow  response  in  carrying  out 
imitative  actions  to  order,  stammering,  or  other  speech 
impediments  not  due  to  local  disease,  mental  confusion, 
difficulty  in  recognizing  familiar  objects,  or  in  remember- 
ing simple  events,  names,  days,  or  dates,  deficient  bladder 
control,  sudden  flushing,  occurrence  of  sudden  pallor, 
"  dead  "  fingers,  persistent  and  extensive  chilblains,  night 
terrors.  Again,  nervous  children  are  very  sensitive,  and 
in  consequence  react  abnormally  to  conditions  that  do 
not  bother  a  normal  child.  Thus,  the  morbidly  sensitive 
youngster  dwells  unduly  on  snubs  and  punishments, 
brooding  over  these  inevitable  drawbacks  of  childhood, 
and  magnifying  quite  small  matters  into  affairs  of  im- 
portance. In  this  way  false  ideas  of  injustice  and  harsh 
treatment,  or  sense  of  having  done  some  dreadful  thing 
render  the  little  victim  pitiably  miserable.  Days  of 
haunting  thought,  in  which  little  interest  is  taken  in 
lessons,  meals  or  play,  are  succeeded  by  dreamful  nights 
which  stiU  further  prejudice  mental  physical  health. 
Similarly,  nervous  children  often  ponder  on  tragic  events 
they  have  heard  about  and  conjure  up  all  sorts  of  horrors 
and  gruesome  possibilities  that  would  never  enter  the 
mind  of  a  healthy  adult.  The  greatest  care  should  be 
given  to  getting  rid  of  these  fears.  They  are  nearly 
always  present  although  a  little  coaxing  and  sympa- 
thetic conversation  may  be  required  to  elicit  them,  for 
children  are  very  reticent  about  their  fancies,  and  hesitate 
to  describe  them  lest  they  be  misunderstood.  Many 
nurse  secret  terrors  of  such  simple  things  as  black  patches 
or  marks  on  a  wall  or  ceiling,  a  badly  stained  bath,  a 
cracked  looking  glass,  or  a  broken  piece  of  furniture. 
Others  do  not  like  woolly  things,  or  fm:ry  surfaces,  some 
are  apprehensive  of  anything  that  moves  suddenly, 
whilst  most  little  ones  are  agitated  by  unfamihar  shape 
or  appearance.    Colour  "  phobias  "  are  by  no  means  rare 


242  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

amongst  children,  and  when  present  are  manifested  by 
screaming  and  signs  of  panic  at  the  sight  of  the  par- 
ticular colom*  objected  to.  Childhood's  fears  have  been 
well  described  by  Charles  Lamb,  who  as  a  child  suffered 
greatly  from  nervous  dreads.  In  one  of  his  essays,  he 
tells  of  the  horror  born  in  him  through  looking  at  the 
picture  of  Samuel  resisting  the  Witch  of  Endor,  in  an  old 
Stackhouse  Bible,  and  of  consequent  terrors  which  dis- 
tressed his  childish  mind  at  night. 

"  I  was  dreadfully  alive  to  nervous  terrors.  The  night 
time,  solitude,  and  the  dark  were  my  hell.  The  sufferings 
I  endured  in  this  nature  would  justify  the  expression. 
I  never  laid  my  head  on  my  pillow,  I  suppose,  from  the 
fourth  to  the  seventh  or  eighth  year  of  my  life — so  far  as 
memory  serves  in  things  so  long  ago — without  an  assur- 
ance, which  realized  its  own  prophecy,  of  seeing  some 
frightful  spectre.  Be  old  Stackhouse  then  acquitted  in 
part  if  I  say  that  to  this  picture  of  the  Witch  raising  up 
Samuel — (0  that  old  man  covered  with  a  mantle  !) — I 
owe,  not  my  midnight  terrors,  the  hell  of  my  infancy,  but 
the  shape  and  manner  of  their  visitation.  It  was  he  who 
dressed  up  for  me  a  hag  that  nightly  sat  upon  my  pUlow, 
a  sure  bedfellow,  when  my  aunt  or  my  maid  was  far  from 
me.  All  day  long,  while  the  book  was  permitted  me,  I 
dreamed  waking  over  his  delineation,  and  at  night  (if  I 
may  use  so  bold  an  expression)  awoke  into  sleep,  and 
found  the  vision  true.  I  durst  not,  even  in  the  dayUght, 
once  enter  the  chamber  where  I  slept,  without  my  face 
turned  to  the  window,  aversely  from  the  bed  where  my 
witch-ridden  piUow  was.  Parents  do  not  know  what  they 
do  when  they  leave  tender  babes  alone  to  go  to  sleep  in 
the  dark.  The  feeling  about  for  a  friendly  arm,  the 
hoping  for  a  famiHar  voice  when  they  wake  screaming, 
and  find  none  to  soothe  them  ;  what  a  terrible  shaking  it 
is  to  their  poor  nerves  !  The  keeping  them  up  till  mid- 
night, through  candle-light  and  the  unwholesome  hours, 
as  they  are  called,  would,  I  am  satisfied,  in  a  medical 


CHILDHOOD  AND  YOUTH  243 

point  of  view,  prove  the  better  caution.  That  detestable 
picture,  as  I  have  said,  gave  the  fashion  to  my  dreams — 
if  dreams  they  were — for  the  scene  of  them  was  invari- 
ably the  room  in  which  I  lay.  Had  I  never  met  with  the 
picture  the  fears  would  have  come  self-pictured  in  some 
shape  or  other :  Headless  Bear,  Black  Man  or  Ape,  but  as  it 
was,  my  imaginations  took  that  form.  It  is  not  book  or 
picture,  or  the  stories  of  foolish  servants,  which  create 
these  terrors  in  children.  They  can  at  most  but  give 
them  a  direction.  Dear  little  T.  H.,  who  of  all  children 
has  been  brought  up  with  the  most  scrupulous  exclusion 
of  every  taint  of  superstition — who  was  never  allowed  to 
hear  of  goblin  or  apparition,  or  scarcely  to  be  told  of  bad 
men,  or  to  read  or  hear  of  any  distressing  story — finds 
all  this  world  of  fear,  from  which  he  has  been  so  rigidly 
excluded,  ah  extra,  in  his  own  'thick-coming  fancies'; 
and  from  his  little  midnight  pillow,  this  nurse-child  of 
optimism  will  start  at  shapes,  unborrowed  of  tradition,  in 
sweats  to  which  the  reveries  of  the  ceU-damned  mur- 
derer are  tranquillity. "^ 

Children  who  wake  screaming  in  fear  must  be  dealt  with 
very  gently  and  lulled  into  a  knowledge  of  personal 
security  by  loving  hands  and  sympathetic  words.  Con- 
fusion, parental  severity,  crowding  round  of  relatives, 
and  sharp  orders  to  be  quiet,  can  only  increase  distress ; 
and  whatever  be  the  cause,  predisposing  or  exciting, 
the  greatest  care  should  be  taken  to  avoid  undue  shock 
when  a  screaming  attack  occurs.  It  is  foolish  to  suppose 
that  a  child  can  be  cured  of  night  terrors  by  slapping  and 
scolding.  Such  crude  measures  only  cause  further  nerve 
disturbance,  and  so  lead  to  worse  attacks.  Fears  may 
haunt  a  child  in  the  daytime,  and  cause  sudden  attacks 
and  visions.  Day-terrors,  though  by  no  means  so  com- 
mon as  night -terrors,  nevertheless  may  be  just  as  severe. 
An  important  practical  point  is  that  sensitive  children 
may   nurse    fears  in  their  waking   hours,  leading  lives 

^  Cliarles  Lamb,  on  "  Witches  and  other  Fears."    See  Essays  oj  Elia. 


244  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

full  of  terror,  never  confiding  in  their  parents  or  nurses ; 
whilst  all  the  time  resultant  nerve  tension  impoverishes 
general  health,  impairs  their  appetite,  and  hinders  their 
proper  physical  and  mental  development.  Such  children 
are  pale  and  listless  with  dark  rings  under  their  eyes  ; 
they  are  sullen  and  suspicious,  look  thoroughly  unhappy, 
and  cannot  be  got  to  take  an  interest  in  games  or  other 
childish  pleasures. 

Next  to  these  dreads  and  other  results  of  over-sensi- 
tiveness, nervous  children  probably  suffer  most  misery 
from  deficient  control  of  the  bladder.  Inabihty  to  regu- 
late the  passage  of  water  causes  a  sensitive  child  infinite 
distress,  in  that  it  constantly  feels  under  a  cloud  for 
having  committed  a  misdemeanour.  Too  often  it  in- 
evitably becomes  the  butt  of  playmates  who  laugh  and 
jeer  at  this  misfortune.  Parents  also  are  sometimes  to 
blame  for  treating  the  matter  as  a  misdeed.  Shoulder- 
ing the  responsibility  thus  thrown  upon  them,  and  being 
often  in  great  physical  discomfort,  life  becomes  a  burden 
to  these  children  who  thereby  become  more  and  more 
nervous.  Inability  to  hold  water  is  a  common  manifesta- 
tion of  nervous  instability  in  early  years.  Happily 
enough,  it  sometimes  represents  only  a  transient  state  of 
nerve  weakness.  The  disability  is  far  more  common  at 
night  than  during  the  day  time,  and  when  allowed  to 
persist  into  later  years  seriously  affects  life  and  work  ; 
consequently  efforts  should  be  made  to  get  rid  of  the 
weakness.  A  policy  of  drift  based  on  the  experience  of 
the  minority  and  the  supposition  that  the  child  will 
"  grow  out  of  it  "  is  much  to  be  deprecated.  When  a  chlid 
gets  to  the  age  for  boarding  school,  or  still  later  when 
a  career  has  to  be  chosen,  the  fact  that  morning  after 
morning  the  bed  is  found  wet  produces  a  sense  of  infirmity 
that  is  highly  detrimental  to  development,  and  may 
prevent  important  work  being  taken  up. 

Parents  should  pursue  a  definite  line  of  action  in  regard 
to  this  weakness.     First  of  all,  they  should  ascertain 


CHILDHOOD  AND  YOUTH  245 

whether  or  no  organic  disease  is  the  cause  of  it,  and, 
having  been  satisfied  that  no  gross  disease  is  present, 
should  take  the  little  sufferer  into  their  confidence  and 
explain  how  the  trouble  is  due  to  a  loss  of  control  that  is 
remediable.  It  is  very  hard  on  a  child  already  sufficiently 
persecuted  by  such  a  troublesome  condition  to  ascribe  its 
difficulties  to  carelessness.  It  is  sad  to  hear  of  unedu- 
cated mothers  punishing  some  little  thing  who  is  strug- 
gling with  nightly  enuresis.  Indeed,  such  ignorance  of 
children's  ailments  ought  no  longer  to  be  possible  in 
these  days  of  schools  for  mothers  and  health  propaganda 
which  afford  ample  facilities  for  parents  to  become  ac- 
quainted with  the  chief  features  of  delicacy  in  their 
children. 

Fortunately  most  cases  are  curable  without  much 
difficulty  if  systematically  treated  on  the  right  lines. 
Mothers  or  nurses  can  often  aboHsh  the  distressing  condi- 
tion by  encouraging  their  small  charges  to  wake  once  or 
fcwice  each  night.  Simple  suggestion  and  explanation  of 
what  is  required  usually  succeeds  in  achieving  the  desired 
end.  When  punishment  is  said  to  have  been  successful 
in  getting  rid  of  the  disability,  it  is  because  the  penalty 
inflicted  happens  to  have  implanted  in  the  child's  mind 
the  necessity  of  waking  during  the  night — a  cruel  method 
of  mental  treatment.  Various  physical  remedies,  in- 
cluding drugs,  and  electricity,  are  sometimes  advocated, 
but  there  should  be  no  need  to  have  recourse  to  this 
means. 

In  the  nursery,  at  school,  and  then  in  that  often  diffi- 
cult period  when  youth  is  passing  into  the  full  fruition  of 
adult  life,  a  great  deal  can  be  accomplished  in  protecting 
and  strengthening  delicate  nerves.  Let  us  take  the 
hygiene  of  the  nursery  first  a/ud  dwell  on  such  issues  as 
are  particularly  important  from  our  present  point  of 
view,  at  once  dealing  with  some  physical  considerations. 
In  the  first  place,  one  notes  that  many  mistakes  are 
made  in  regard  to  the  feeding  of  children  of  the  neurotic 


246  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

type,  with  the  result  that  they  so  often  become  thin  and 
ill  from  want  of  nom'ishment.  Sometimes  they  become 
dyspeptics  because  they  consistently  bolt  food  that  is  un- 
palatable to  them  once  they  realize  that  they  are  not  to 
be  "let  off  "  by  unwise  parents  ;  sometimes  they  suffer 
from  being  left  too  much  to  their  own  wishes. 

The  first  rule  for  a  mother  to  follow  when  arranging  the 
diet  of  a  nervous  child  is  to  close  her  ears  to  popular 
absiu-dities  and  rely  on  common  sense  and  expert  advice 
when  it  is  needed.  Common  sense  wiU  obviate  too  strict 
rules  and  combine  firmness  with  due  consideration  for 
the  child's  individual  requirements.  If  a  child  does  best 
on  a  diet  of  sweet  things,  why  not  let  him  have  it.  If  he 
craves  for  pure  cold  water,  what  harm  will  it  do  him  ? 
Yet  for  some  reason  there  is  a  general  tendency  to  feed 
children  on  the  most  plain  and  tasteless  fare,  which, 
although  acceptable  enough  to  the  strong,  healthy 
youngster  whose  nerves  are  not  likely  to  trouble  him 
then  or  thereafter,  is  simply  revolting  to  the  highly  strung. 
Again,  people  insist  on  children  sitting  over  a  meal  until 
they  have  finished  up  whatever  may  have  happened  to 
have  been  provided.  The  "  finishing  up  "  process  may 
be  completed  aU  right,  but  probably  through  the  method 
of  "  bolting."  Thus  the  child's  delicate  stomach  is  filled 
with  a  mass  of  unmasticated  food  that  is  most  difficult  to 
digest,  and  by  the  irritation  it  sets  up  may  impair  health 
in  many  ways. 

Another  point  about  diet  is  that  care  should  be  taken 
to  dissociate  the  idea  of  powders  and  medicines  from  any 
of  the  foods  that  are  in  common  use.  A  nasty  tasting 
powder  concealed  in  a  spoonful  of  jam  may  engender 
such  a  dislike  for  jams  of  all  kinds  that  the  child  once 
victimized  in  this  way  will  refuse  to  touch  them  again  ; 
and  this  is  an  important  consideration  when  we  remem- 
ber how  useful  a  part  jams  play  in  making  the  simple  fare 
of  the  nm"sery  and  schookoom  more  appetizing  than  it 
otherwise  would  be.     Similarly,   cod-liver  oil  thought- 


CHILDHOOD  AND  YOUTH  247 

lessly  given  in  milk  may  result  in  giving  great  dislike  for 
that  most  nourishing  commodity.  Cod-liver  oil  is  a 
most  valuable  support  for  delicate  children,  but  it  should 
always  be  given  as  an  emulsion,  preferably  with  iron,  or 
in  one  of  the  palatable  forms  prepared  by  so  many  well- 
known  jfirms  of  chemists. 

In  a  word,  children  require  plenty  of  light,  good 
nourishing  food.  Milk  must  not  be  given  in  super- 
abundance, but  the  writer  likes  to  see  cream  on  the 
nursery  table  daily.  Fruit  and  sweets  also  have  their 
proper  place  not  merely  as  extras  but  as  regular  elements 
of  nourishment  and  children's  feeding.  It  is  mainly  a 
question  of  common  sense,  moderation,  and  regularity 
as  to  whether  a  child  gets  the  right  food  and  the  right 
nourishment.  The  delicate  nervous  child  is  in  danger  of 
Buffering  through  too  much  unsuitable  food  rather  than 
the  reverse.  He  really  wants  small  amounts  of  very 
digestible  food  at  regular  intervals,  and  is  more  dependent 
on  taking  something  between  the  chief  meals  of  the  day 
than  are  his  stronger  brothers  and  sisters.  Moreover,  as 
he  is  very  often  constipated,  the  regulation  of  his  bowels 
must  be  made  a  matter  of  very  careful  routine.  When 
digestion  is  so  disturbed  that  night  terrors  are  thereby 
encouraged  or  accentuated,  special  care  must  be  given  to 
drawing  up  a  daily  diet  table  suitable  for  the  little  sufferer, 
no  heavy  meal  being  given  later  than  at  most  three  hours 
before  bed  time. 

Turning  now  to  the  mental  side  of  hygiene  in  the 
nursery,  let  us  note  at  once  it  is  the  over-sensitiveness  of 
the  nervous  child  that  requires  primary  consideration. 
Thus,  unwholesome  brooding  often  follows  where  chil- 
dren are  threatened  with  dire  penalties  for  small  mis- 
deeds. The  quick  thought  of  the  sensitive  child  at  once 
grasps  the  full  horror  of  being  turned  into  a  cat  or  dog  ; 
spirited  away  by  a  black  man,  fetched  by  a  policeman, 
or  burned  eternally  in  the  hereafter.  One  only  hopes 
that  modern  educational  methods  and  the  better  training 


248  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

of  children's  nurses  will  soon  banish  these  silly  threats 
from  our  nurseries.  Such  suggested  terrors  not  infre- 
quently give  rise  to  distressing  nightmares  causing  the 
excited  child  suddenly  to  wake  up  screaming,  trembling, 
and  obviously  in  deadly  fear.  It  is  tragic  that  such 
attacks  should  ever  be  occasioned  by  the  careless  threats 
of  irresponsible  people.  That  the  latter  have  no  idea  of 
the  dread  they  are  suggesting  to  the  little  ones  in  their 
care  is  no  excuse  for  stupid  cruelty.  Let  all  thoughts  of 
relentless  punishment,  bogies,  and  ghosts  be  kept  out  of 
the  nursery.  Even  fairy  tales  and  fables  should  always 
be  qualified  by  teaching  that  ghosts  and  goblins  have  no 
real  power  ;  that  the  smallest  child  is  stronger  than  the 
biggest  bogey.  Once  unhealthy  thoughts  get  root  in 
childish  thought  it  is  difficult  to  uproot  them,  and  every 
one  who  thinks  to  make  a  child  good  by  threats  of  hob- 
goblins merits  severe  censure.  In  the  minds  of  some 
children  terrifying  thoughts  produce  wide-spread  results 
not  infrequently  leading  to  nerve  disturbances  that  may 
persist  and  prove  a  handicap  throughout  adult  life. 
Many  a  neurasthenic  is  tormented  by  obsessing  thoughts 
that  have  their  origin  far  back  in  some  mental  crisis  of 
childhood.  Let  the  child-mind  be  filled  with  beautiful 
ideas  symbolized  by  fairies,  guardian  angels,  and  good 
sprites,  and  for  the  sake  of  grown-up  nerves,  if  for  no 
more  worthy  reason,  let  it  be  spared  terrors  that  are  often 
thoughtlessly  inflicted  on  it.  Children  who  fear  the  dark 
and  lie  panting  in  terror  when  left  alone  at  night  owe 
their  alarms  to  some  false  fear -thought  working  their 
minds.  Let  it  be  remembered  that  where  such  fearful- 
ness  is  not  dealt  with  sympathetically  the  fear-thought 
may  soon  develop  to  such  a  degree  that  terrifying  hal- 
lucinations occur,  and  the  child  go  nearly  mad  with  fright 
at  some  supposed  apparition.  There  are,  indeed,  some 
nern'otic  children  whose  mobile  minds  evolve  fear-thoughts 
out  of  very  little.  So  long  as  they  talk  about  them  openly 
the  ill  effects  of  these  terrors  is  minimized,  but  once, 


CHILDHOOD  AND  YOUTH  249 

through  misunderstanding  or  other  cause,  they  keep 
their  fears  secret,  there  is  risk  of  serious  excitement. 
Suppressed  horrors  sooner  or  later  become  manifested 
as  night  terrors,  general  ill  health,  sometimes  convul- 
sions, and  in  later  life  by  neurasthenic  or  hysterical 
states. 

Although  it  is  so  clear  that  particularly  in  childhood 
does  care  in  training  enable  us  to  dispel  or,  at  any  rate, 
to  minimize  latent  possibilities  of  neurotic  disturbance  in 
later  life,  the  fact  remains  that  many  people  over-estimate 
the  strength  of  the  growing  nervous  system,  and  the 
capacity  of  the  child-mind  for  assimilating  knowledge 
without  strain.  A  mistake  of  this  kind  may  and  does 
frequently  result  in  irreparable  damage.  The  whole 
tendency  of  natural  processes  in  childhood  is  towards 
nutrition,  whilst  all  through  growing  years  Nature  makes 
increasing  efforts  to  develop  the  brain.  Any  undue  stress 
on  the  developing  nervous  system  not  only  strains  a 
particularly  delicate  organ,  but  leads  to  excessive  calls  on 
general  bodily  energy  to  compensate  the  over-worked 
brain.  At  a  time  when  Nature  is  making  great  efforts 
towards  building  up  the  body  generally,  risk  is  incurred 
when  the  balance  is  seriously  disturbed  by  undue  demands 
on  behalf  of  some  particular  part  of  the  system.  If  a 
child  is  made  to  take  too  much  muscular  exercise,  or  to 
indulge  too  freely  in  out-door  games  and  exercise,  the 
growing  brain  and  nervous  system  has  to  suffer  ;  on  the 
other  hand,  where  excessive  mental  work  is  asked  for  the 
developing  body  is  thereby  deprived  of  some  of  the 
nutriment  that  is  its  due.  Where  a  careless  system  of 
education  and  training  leads  to  excessive  demands  on 
both  brain  and  body  the  most  serious  dangers  are  run, 
and  the  whole  process  of  successful  evolution  may  be 
frustrated.  Some  rather  delicate  children  naturally  tend 
to  be  studious,  and  where  a  wise  training  does  not  see 
that  the  demands  made  upon  their  bodies  and  minds  are 
reasonable  and  balanced  they  usually  drift  into  a  routine 


250     THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

in  which  they  learn  too  quickly  and  too  much.  Thus  is 
developed  a  not  unfamiliar  type  of  youngster  with  puny 
body  and  quick  excitable  mind.  The  pity  of  it  is  that  it 
is  just  the  more  finely  constructed  and  so  particularly 
plastic  brains  that  get  imposed  on.  The  quick  child  is 
regarded  joyfully  and  triumphs  of  genius  foretold  for 
it  ;  the  unfortunate  victim  of  mistaken  praises  is  en- 
couraged to  pass  test  after  test,  whilst  an  ever-growing 
pile  of  useless  rewards  blinds  the  parents'  eyes  to  the 
danger  incurred.  Many  individuals  can  attribute  a  serious 
mental  handicap  in  after  life  to  strain  from  over-study  in 
childhood. 

There  is  far  too  great  a  tendency,  especially  in  small 
schools,  for  children  of  quick  brains  to  be  over-trained 
mentally  at  the  expense  of  little  bodies  which  require 
more,  rather  than  less,  attention.  Competitions  and 
school  tests  have  their  uses,  but  there  is  a  great  deal  of 
mischief  done  by  study  for  examinations  between  the 
ages  of  twelve  and  seventeen  years.  There  is  no  reason 
why  any  child  should  have  to  undergo  unreasonable 
strain  of  body  or  mind  during  school  life,  but  it  is  par- 
ticularly urgent  that  those  who  are  delicate  should  have 
their  physiological  requirements  carefully  studied.  The 
maximum  amount  of  work  which  a  boy  or  girl  should 
have  to  do  during  school  years  is  about  thirty  hours  a 
week  ;  that  means  an  average  of  just  under  five  hours  a 
day,  which  may  be  divided  up  into  three  hours  in  the 
morning,  one  for  the  afternoon,  and  one  for  preparation 
for  the  next  day's  work.  This  should  be  the  maximum 
for  this  particular  period,  but  is  commonly  exceeded  in 
the  ordinary  routine  of  school  life.  Moreover,  if  "  pre- 
paration "  for  the  next  day's  work  is  not  carefully  mapped 
out,  it  may  mean  a  serious  and  unnecessary  draft  on 
Nature's  bank  of  nerve-energy.  Hours  that  ought  to  be 
devoted  to  recreation,  rest  and  sleep,  should  never  be 
encouraged  for  school  preparation. 

Then  there  is  the  question  of  sleep  for  school  children. 


CHILDHOOD  AND  YOUTH  251 

They  should  spend  at  least  nine  hours  out  of  the  twenty- 
four  asleep,  and  as  they  usually  have  to  get  up  at  about 
seven  o'clock  in  the  morning,  it  is  clear  that  the  older 
ones  should  be  in  bed  by  ten  o'clock  at  night,  and  therefore 
should  certainly  cease  work  at  least  an  hour  before  that 
every  evening  ;  for  it  is  quite  unreasonable  for  children 
to  go  to  bed  with  thoughts  full,  alert  and  excited  by 
recent  lessons.  Again,  under  proper  conditions  of 
mental  hygiene,  every  boy  and  girl  ought  to  have 
some  hobby  which  should  occupy  him  or  her  for 
an  hour  daily  so  as  to  rest  the  mind  from  thoughts 
of  school. 

In  the  matter  of  physical  exercises  for  school  children 
one  often  finds  ignorance  of  natural  laws.  Sometimes  it  is 
considered  that  sufficient  fresh  air  and  exercise  are  obtained 
if  the  youngsters  over-exert  themselves  at  violent  games 
twice  a  week;  a  few  days'  mental  stress,  relieved  by 
physical  strain  is  a  system  that  has  been  only  too  common, 
and  is  cited  here  merely  as  an  example  of  what  should  be 
avoided.  The  fact  that  numbers  of  young  people  break 
down  in  early  adult  hfe  is  sufficient  warning  that  in  any 
case  greater  attention  should  be  given  to  the  training  of 
children  of  the  nervous  type.  Even  now  it  is  insufficiently 
reahzed  how  often  the  mental  catastrophies  of  early  adult 
life  are  largely  due  to  faulty  school  conditions.  The  question 
therefore  arises  as  to  what  we  are  going  to  do  to  remedy 
faults  in  our  educational  system  which  tend  to  bring  out 
rather  than  eradicate  tendencies  to  nervous  disorders. 
How  are  we  going  to  ensure  that  our  nervous  youngsters 
shall  be  protected  and  fostered  mentally  and  physically  ? 
Clearly,  the  remedy  is  to  be  found  in  the  establishment  of 
a  rational  system  of  school  hygiene. 

Thus  the  daily  programme  for  delicate  boys  and  girls 
should  be  on  the  following  lines.  An  early  breakfast 
followed  by  half  an  hour's  gentle  exercise  in  the  open  air ; 
the  morning  work  should  then  consist  of  not  more  than 
four  periods  of  not  more  than  three-quarters  of  an  hour 


252  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

each  ;  the  last  lesson  should  be  verbal  instruction  by 
a  good  teacher,  this  entailing  much  less  effort  than 
reading  class-books  or  working  out  mathematical  prob- 
lems. The  afternoon  should  be  spent  in  the  open  air  as 
far  as  possible,  exercises  and  games  being  carefully  super- 
vised and  graduated  according  to  the  capacity  of  indi- 
viduals. During  the  late  afternoon  and  evening  there 
should  be  one,  or  at  most  two  further  periods  of  forty-five 
minutes  for  study,  whilst  the  time  between  the  last  meal 
of  the  day  and  bed-time  should  be  given  up  to  pleasant 
relaxation.  In  this  way  the  evening  hour  of  study  is,  in 
the  case  of  nervous  children,  finally  eliminated  ;  there 
should,  indeed,  be  no  hesitation  in  omitting  late  study  for 
neurotic  boys  and  girls.  The  highly-strung  child  best 
conserves  his  energies  whilst  strengthening  his  mental 
control  and  developing  his  faculties,  when  giving  up  his 
evenings  to  such  occupations  as  drawing, developing  photo- 
graphs, or  other  instructive  hobbies. 

Then,  apart  from  details  of  daily  routine,  everything 
should  be  done  to  avoid  making  school  a  place  of  mental 
torture  or  physical  discomfort  for  nervous  children.  Life 
there  should  be  made  as  bright  and  homely  as  possible 
so  that  the  difficulties  of  adaptation  to  environment  which 
so  constantly  trouble  the  possible  neurasthenic  may  be 
minimized.  It  really  comes  to  this,  then,  that  where  a 
child  exhibits  signs  of  brain  instability  it  is  better  away 
from  the  rough  and  tumble  of  ordinary  school  life.  On  the 
other  hand,  the  dangers  of  fixing  the  nervous  habit  by 
coddling  and  too  much  morbid  sympathy  at  home  must 
certainly  be  avoided.  We  want  a  few  more  centres  where 
the  educational  care  of  the  nervous  child  is  especially 
undertaken  by  those  who  have  studied  these  matters. 
Given  a  fair  chance,  the  nervous  child  will  often  develop 
into  a  highly  successful  man  or  woman  ;  let  it  be 
remembered  that  each  child  starts  life  with  an  inherent 
personality  that  will  ultimately  make  good  if  properly 
fostered  and  guided  in  the  right  way.    Here  we  touch 


CHILDHOOD  AND  YOUTH  253 

upon  problems  of  real  national  importance,  and  matters 
which  it  is  to  be  hoped  will,  in  the  future,  receive  much 
more  attention  from  public  authorities  than  they  have 
done  in  the  past.  When  nursery  and  school  life  are 
based  upon  true  principles  of  mental  and  physical  hygiene 
the  nervous  tendencies  of  child  life  will  far  more  often  be 
prevented,  than  is  the  case  at  present,  from  developing 
into  the  psycho-neuroses  of  adult  life.  No  training  in 
after-life  can  provide  the  reserve  of  nerve-energy  that 
can  be  built  up  during  school  days  by  reasonable 
attention  to  Nature's  laws  and  needs. 

R.  L.  Stevenson  has  said  that  we  write  our  diaries  "  in 
airy  characters  "  upon  our  brains.  It  is  certain  that  child- 
hood's experiences  leave  their  permanent  mark  on  the 
developing  nervous  system,  and  many  a  delicate  brain  is 
ruined  through  exposure  to  over-rough  stimuli  and  un- 
necessary stress  during  the  period  of  growth.  Similarly, 
protection  is  not  often  enough  given  to  girls  and  boys  who 
need  it  during  the  years  that  lead  them  from  irresponsible 
youth  to  responsible  maturity.  This  period  of  adolescence 
is  most  critical  for  everyone,  and  where  there  is  inherent 
deUcacy  of  nerve  tissues  or  abnormal  mobility  of  mind 
the  passage  to  adult  life  only  too  often  ends  in,  or  is  inter- 
rupted by  a  wreck.  The  decade  between  seventeen  and 
twenty-seven  is  productive  of  many  sad  breakdowns, 
not  a  few  of  which  could  be  prevented.  It  ought  to 
be  one  of  the  proud  claims  of  applied  psychology 
and  neurology  in  the  future  that  our  over-sensitive 
young  people  are  far  more  often  given  a  safe  voyage 
through  the  troubled  waters  of  adolescence  than  is  the 
case  to-day. 

There  has  been  far  too  strong  a  tendency  to  treat  the 
nervous  discomforts  of  youth  as  negligible  quantities, 
and  to  urge  their  minor  importance  by  telling  young  men 
and  maidens  just  to  pull  themselves  together  and  not  be 
foolish.  Thus,  instead  of  gaining  that  confidence  and 
analytical  understanding  of  dangerous  mental  states  and 


254  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

nervous  weakness,  the  whole  point  of  the  problem  has 
been  missed,  and,  indeed,  the  problem  itself  ignored. 
One  of  the  characteristics  of  youth  and  maidenhood  is 
over-sensitiveness  to  personal  criticism,  and  the  unsym- 
pathetic handling  of  nervous  difficulties  quickly  leads 
to  reticence  about  them.  There  is  nothing  worse  for 
those  troubled  in  this  way  than  the  constant  bottling  up 
of  their  perplexities.  Many  a  man  and  woman  suffers 
from  distressing  breakdown  in  later  life  as  a  result  of 
pent-up  emotional  stress  during  the  period  of  adolescence  ; 
whereas  careful  analysis  of  the  difficulty  with  sympa- 
thetic directions  would  have  prevented  the  setting  up 
of  a  chronic  source  of  mental  irritation.  Similarly,  one 
can  trace  many  breakdowns,  or  states  predisposing  to 
breakdown,  to  misunderstanding  of  misery  suffered  by 
little  children  of  nervous  temperament. 

We  need  a  greater  understanding  of  the  psychology  of 
youth  ;  we  need  to  study  a  good  deal  more  closely  the 
impetuous  fire,  the  fascinating  way  of  them  and  the  subtle 
sensitivity  of  those  who  assume  a  natural  course  over  the 
threshold  that  leads  to  the  full  inheritance  of  manhood 
and  womanhood.  Particularly  do  we  want  a  better 
understanding  of  the  unwholesome  channels  into  which 
youthful  thought  sometimes  tends  to  wander,  especi- 
ally in  those  of  nervous  temperament  and  delicate 
physique.  Increasing  pursuit  of  the  answers  to  the 
riddles  thus  suggested  will  enable  us  to  give  more 
and  more  help  to  those  who  find  youth  not  so  much 
a  time  of  joyous  life  as  an  age  of  uncertainty  and 
discontent. 

Often  enough  adolescence  is  a  period  of  extravagance, 
and  those  of  matm-e  years  are  sometimes  inclined  to 
judge  too  harshly  those  who,  in  the  wildness  of  youth,  let 
their  behaviom?  offend  the  conventions.  Let  it  be  re- 
membered that  when  in  early  life  eccentricities  of  conduct 
pass  a  certain  point,  it  brmgs  those  concerned  within  the 
category  of  nervous  disorder,  and  really  occasions  them 


CHILDHOOD  AND  YOUTH  255 

to  merit  sympathy  rather  than  censure.  Apropos  of  this 
the  "  flapper  "  whose  particular  phase  of  adolescence  has 
lately  attracted  popular  attention. 

The  true  facts  are  that  the  "  flapper,"  who,  by  uncon- 
trolled spirits  and  occasionally  immodest  behaviour, 
sometimes  shocks  her  seniors,  is  carried  away  by  the 
exuberance  of  developing  youth.  It  is,  indeed,  quite 
normal  for  the  profound  changes  that  proceed  in  the 
human  mind  and  body  between  the  years  of  childhood 
and  adult  life  to  be  accompanied  by  emotional  outbursts. 
The  emotions  are  not  yet  curbed  by  that  judgment  which 
takes  its  place  as  an  important  part  of  the  individual's 
mental  make-up  in  later  life.  It  is  these  changes  and 
varjdng  mind  attitudes,  indeed,  that  go  to  make  the 
periods  of  puberty  and  adolescence  so  interesting  to  the 
student  of  human  nature. 

Particularly  is  it  to  be  expected  that  the  changes  which 
accompany  preparation  for  the  great  function  of  woman- 
hood should,  as  a  matter  of  course,  produce  both  reflec- 
tions in  the  body  and  echoes  in  the  mind.  The  bodily 
reflections  are  recognized  by  the  physician  as  hysteria, 
headaches,  anaemia,  and  nerve  troubles  of  all  degrees  of 
gravity  ;  the  mental  echoes  and  accompaniments  thereof 
present  themselves  as  those  emotional  phases  beloved  by 
the  novelist.  It  may  be  said  at  once  that  were  it  not  for 
these  cataclysms  in  the  sphere  of  the  emotions  due  to  the 
general  disturbance  of  adolescence  the  world  would  miss 
both  in  romance  and  real  life  many  of  the  tragedies  and 
comedies  of  affairs  of  love,  hatred  and  jealousy  in  daily 
life.  The  subject  of  adolescent  changes  really  is,  of 
course,  the  unwitting  victim  of  her  mental  and  physical 
vagaries  ;  and  society  has  erected  safeguards  to  the  con- 
duct and  mentality  of  maidenhood  in  the  shape  of 
chaperons  and  conventions  that  subject  her  possibly 
unwise  inclinations  to  the  rule  of  a  more  mature  judg- 
ment than  she  herself  possesses.  Heightened  emotions 
lead  to  increased  suggestibility,  and  the  new  and  odd 


256  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

interest  which  the  adolescent  boy  or  girl  suddenly 
becomes  possessed  of  in  regard  to  members  of  the 
opposite  sex,  unquestionably  achieves  such  dominance 
for  a  time  that  they  are,  as  it  were,  hypnotized  and 
unable  to  exercise  full  discretion  in  their  friendships. 

Taking  the  characteristics  of  feminine  adolescence  in 
great  detail  one  finds  that  there  is  an  increasing  self- 
interest  which  arises  paradoxically  enough  from  the 
scarcely  conscious  wish  to  become  interesting  in  the  eyes 
of  the  other  sex  ;  definite  wish  to  marry  has  not  yet 
arisen,  but,  at  the  same  time,  instinct  strongly  prompts 
behaviour  which  tends  to  make  its  subject  an  object  of 
attraction  to  men.  The  emotional  outlook  quite  over- 
shadows the  none  too  strongly  developed  reason  and 
judgment  of  a  girl.  As  secondary  results  selfishness; 
obstinate  following  of  lines  of  conduct  which  may  appear 
irrational  or  even  scandalous  to  parents  ;  determination 
to  secure  as  much  admiration  as  possible  tend  to  make 
the  enchanted  young  woman  an  unstable  and  unreliable 
member  of  society  for  the  time  being.  Unable  to  exercise 
judgment  for  herself,  she  is  only  too  liable  to  behave  in 
a  way  that  scandalizes  her  friends  and  relatives,  although 
she  is  not  in  the  least  possessed  of  vicious  tendencies. 

In  times  of  great  emotional  strain,  when  social  rules 
are  to  some  extent  temporarily  allowed  to  lapse,  ex- 
aggeration of  the  normal  characteristics  of  developing 
maidenhood  are  only  to  be  expected,  for  the  maiden  can- 
not help  reflecting  the  excitements  of  the  days  in  which 
she  finds  herself.  It  is  obvious,  then,  that  in  the  indis- 
cretions and  apparent  immodesty  of  flapperdom  we 
have  nothing  but  the  irresponsible  conduct  of  adoles- 
cence involuntarily  aggravated  by  its  representatives 
without  immoral  intent.  Indeed,  unkind  critics  of  the 
flapper  should  note  that  by  her  very  fickleness  she  illus- 
trates the  characteristics  of  her  peculiar  mental  condi- 
tion, for  the  swift  emotions  of  adolescence  have  little 
depth,  and  her  friend  of  one  day  and  her  sweetheart  the 


CHILDHOOD  AND  YOUTH  257 

next  may  be  the  object  of  complete  indiSerence  yet  a 
little  later.  As  the  late  Sir  Thomas  Clouston  observed  : 
"  We  know  that  the  love-making,  the  flirting,  the  engage- 
ments to  marry,  and  the  broken  hearts  of  the  adolescents 
are  not  really  very  serious  affairs.  The  cataclysms  of 
life  do  not  happen  then." 


CHAPTER  VIII 

PEINCIPLES  OF  SELF-HELP 

The  will  to  be  well — Misconceptions  about  self-help — Importaaice  of 
co-operation  between  patient  and  doctor — Conscientiousness  in 
carrying  out  instructions — Holding  on  during  set-backs — Self- 
reverence,  self-knowledge,  self-control — Strengthening  self-control 
— Exercising  inhibitory  power — Self-denial — Getting  rid  of  fear — 
Nerve-health  and  rehgious  faith. 

IN  aU  forms  of  ill-health,  but  particularly  when  cora- 
bating  nervous  troubles,  the  doctor  welcomes  the 
will  to  be  well  as  a  most  valuable  aUy,  To  obtain  the 
co-operation  of  the  invahd  is,  indeed,  a  very  important 
step  forward.  As  disturbed  thought-control  plays  such 
a  leading  role  in  all  forms  of  nervous  breakdown,  it  is 
clear  that  any  determined  effort  by  the  individual  con- 
cerned to  order  his  thoughts  and  carry  out  a  systematic 
plan  of  mental  self-help  is  going  to  be  an  invaluable  aid 
to  recovery.  But  so  often  is  it  found  that  people  believe 
all  their  difficulties  both  in  mind  and  body  come  from 
some  physical  source  that  it  is  well  to  exercise  tact  in 
approaching  the  question  of  self-help.  When  the  sick 
person  is  under  the  impression  that  only  a  physical 
remedy  can  help  he  entirely  fails  to  grasp  the  significance 
of  trying  to  help  himself  by  thought-control.  Moreover, 
often  he  is  not  at  aU  sure  that  requests  to  him  to  help  in 
the  treatment  by  using  his  own  will-power  do  not  imply  a 
suggestion  that  his  illness  is  in  part  due  to  his  own  slack- 
ness, a  suggestion  he  sharply  resents.  Consequently,  the 
doctor  may  often  spend  a  quarter  of  an  hour  usefully 
in  explaining  just  why  self-help  is  so  valuable  in  this 

258 


PRINCIPLES  OF  SELF-HELP  259 

class  of  malady,  and  in  what  directions  it  is  most  likely 
to  b6  most  successful.  The  invalid  seems  to  argue  fret- 
fully :  "  Here  am  I  crippled  by  a  miserable  condition 
that  makes  life  a  burden,  prevents  my  doing  the  work  I 
very  much  want  to  get  on  with,  and  now  you  come  along 
and  talk  about  self-help  !  Gracious  Heavens  !  If  I  could 
have  helped  myself  out  of  this  state  of  torment  I  would 
have  been  weU  long  ago.  Not  at  all.  I  am  tired  of  the 
whole  thing — it  must  have  a  definite  physical  basis.  I 
wash  my  hands  of  all  responsibility  in  the  matter.  To 
get  me  weU  is  my  doctor's  task  entirely." 

This  not  unusual  attitude  can  only  be  combated  suc- 
cessfully by  patient  conversation  in  which  the  relation  of 
the  invalid's  will  and  thought  to  his  iUness  is  carefully 
explained.  In  addition  to  this,  it  should  be  pointed  out 
.how,  after  all,  self-help  is  by  no  means  only  a  question  of 
mind  discipline,  but  concerns  such  things  as  regulation  of 
rest,  carrying  out  prescribed  recreations,  conscientiously 
following  any  rules  of  hygiene  that  may  be  laid  down,  or 
making  an  effort,  where  effort  is  necessary,  to  persevere 
with  a  dietary  or  remedies  that  are  not  particularly  palat- 
able. God  helps  those  who  help  themselves,  says  the  old 
proverb.  Never  was  a  truer  word  spoken  about  those 
exhausted  in  nervous  system  ;  no  better  saying  can  they 
find  as  their  daily  watchword.  Self-help  means  exercise  of 
mind,  and  exercise  of  mind  takes  us  nearer  to  or  further 
from  God,  just  as  we  will.  To  walk  healthward  is  to  go 
Godward.    To  attempt  to  go  Godward  is  to  find  help. 

Let  those  bothered  by  nerves  remember  that  every 
possible  influence  has  to  be  brought  to  bear  in  restoring 
health  ;  let  them  bear  in  mind  how  the  balance  sways 
for  weeks  and  months  between  recovery  and  relapse, 
particularly  let  experience  remind  them  how  true  it  is 
that  the  last  straw  of  help  breaks  the  back  of  the  illness — 
then,  holding  in  mind  these  things,  they  will  realize 
clearly  how  quite  a  small  effort  of  self-help  may  finally 
tip  the  balance  in  their  favour.    In  a  word,  the  more  the 


260  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

invalid  will  carry  out  things  suggested  for  helping  himself 
the  more  thorough  is  the  attack  on  his  troublesome 
malady. 

Infinitely  more  hopeful  are  the  prospects  of  speedy 
recovery  when  the  patient  pulls  his  full  weight  in  the 
contest  ;  by  so  doing  he  not  only  does  useful  work 
directly  but  encourages  doctors,  nurses,  friends  and 
relatives  in  their  efforts  to  bring  him  through  the  slough 
of  despond  we  know  as  nervous  breakdown,  and  so  in- 
duces them  to  redouble  their  own  efforts. 

In  matters  of  detail  it  is  extremely  important  for 
people  to  carry  out  conscientiously  any  simple  tasks 
set  as  self-help  exercises.  Be  it  a  Jig-saw  puzzle  to 
strengthen  attentive  control,  be  it  a  game  of  patience  to 
assist  concentration,  or  a  light  gardening  job,  some  copy- 
ing, a  little  carpentering,  or  some  painting — be  it  a  slight 
task  or  a  reaily  useful  one — ^it  must  be  carried  out  with  a 
will  and  intention  to  do  the  best,  and  leave  the  rest. 
That  is  all  one  asks  ;  that  the  one  helped  shall  himself 
do  his  bit  in  the  work  of  getting  him  weU.  Never  mind 
if  it  is  a  poor  "  best  "  or  a  good  "  best  '* — it  is  the  inten- 
tion and  attempt  that  counts  and  really  helps.  Show  us 
the  nerve-sufferer  v,^ho  is  making  very  slow  progress, 
but  nevertheless  is  doing  his  "  best  "  to  co-operate — then 
you  will  be  showing  one  who  is  most  certainly  going  to  get 
weU.  Time  after  time  does  it  happen  that  in  one  of  those 
familiar  crises  which  come  to  disturb  steady  progress 
and,  without  warning,  thrust  the  invalid  back  to  sullen 
misery,  does  it  occur  that  the  victim's  ability  to  hold  on — 
to  make  use  of  self-help  principles — takes  the  sting  out  of 
these  "  nervous  attacks,"  and  prevents  that  tragic  sur- 
render which  is  only  too  often  the  fate  of  those  who 
struggle  without  proper  support  or  instruction.  To  pre- 
vent the  hopelessness  that  leads  to  such  surrenders  must 
always  be  one  of  our  leading  aims,  for  we  know  that  a 
letting-go  of  this  kind  may  need  weeks  of  good  work, 
whilst,  on  the  contrary,  the  conquest  of  such  threatened 


PRINCIPLES  OF  SELF-HELP  261 

set-backs  enormously  strengthens  the  foundation  for 
future  health  which  is  laboriously  being  built  up. 

Bacon  said,  "  The  fit  man  and  the  right  man  is  he  who 
has  constancy  of  mind,  so  that  he  enjoys  the  good  without 
disdain  and  endures  the  bad  without  impatience."  What 
an  ideal  for  those  of  over-active  thought  and  feeling  ! 
Such  an  ideal  that  if  we  take  it  as  a  standard  of  the 
normal  as  opposed  to  the  nervous  few  people  would  be 
acquitted  of  neurosis.  Nevertheless,  that  is  the  sort  of 
balance  of  mind  that  we  should  all  aim  at ;  it  is 
the  attitude  pointed  to  by  philosophers  as  the  pearl 
beyond  price  ;  the  goal  sought  by  ascetics  for  centuries  ; 
the  ideal  of  priest,  prophet  and  poet.  Stevenson's  old 
sheriff  showed  to  perfection  the  calm  dignity,  the  stately 
certainty,  the  graceful  equanimity  of  those  who  feel  their 
feet  on  a  rock  and  their  minds  unthrilled  by  the  storms 
and  troubles  of  the  world.  The  very  antithesis  of  the 
neurasthenic,  yet  withal  exhibiting  quickness  of  thought 
and  mental  ability  with  his  tranquillity.  Of  Mr.  Hunter's 
room — he  was  Robert  Hunter,  Sheriff  of  Dumbarton — 
we  are  told  that  no  "  young  man  could  have  found  else- 
where a  place  so  set  apart  from  envy,  fear,  discontent,  or 
any  of  the  passions  that  debase  ;  a  life  so  honest  and  com- 
posed ;  a  soul  like  an  ancient  violin,  so  subdued  to  har- 
mony, responding  to  a  touch  in  music — as  in  that  dining- 
room,  with  Mr.  Hunter  chatting  at  the  eleventh  hour, 
under  the  shadow  of  eternity,  fearless  and  gentle."  We 
want,  then,  a  firmness  of  thought,  a  control  of  feeling, 
such  that  emotional  storms  beat  harmlessly  over  our 
heads,  or  better,  die  down  before  they  are  really  aroused. 

Tennyson  epitomized  a  volume  of  self-help  instruc- 
tions when  he  wrote  : 

"SeK- reverence,  self-knowledge,  self-control. 
These  three  alone  lead  life  to  sovereign  power." 

His  beautiful  couplet  makes  a  golden  rule  for  the  nerv- 
ous to  live  by  ;    something  definite  to  keep  in  view,  a 


262  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

triple  goal  always  increasing  in  worth  and  glory  the 
nearer  we  get  to  it  ;  a  triple  crown  for  those  who  have 
well  stayed  the  course  in  life's  great  race.  But  in  the 
splendour  of  the  reward  let  us  not  forget  its  magic  powers 
of  protection,  for  the  wearer  of  the  triple  crown  symboliz- 
ing self-reverence,  self-knowledge,  self-control,  is  thereby 
rendered  proof  against  the  assaults  of  many  of  those 
mental  demons  which  together  bolster  up  the  bogey  of 
nervousness.  Our  preliminary  study  of  the  chief  mani- 
festations of  nervous  disorder  showed  us  how  commonly 
poor  self-control  weakens  the  defences  against  this  kind 
of  malady,  and  how  many  troublesome  symptoms  are 
the  direct  expression  of  weakness  in  self-command. 

Here,  then,  is  one  way  in  which  self-help  can  be  exer- 
cised with  advantage.  In  a  word,  if  anyone  suffering 
from  nervous  disorder  will  do  no  more  than  promise  to 
attempt  to  regain  lost  control — ^that  is,  to  increase  the 
amount  of  control  over  self  that  happens  to  be  present 
at  the  time  of  illness — ^then  a  very  important  step  will 
have  been  taken  towards  the  ultimate  restoration  of 
nerve-harmony.  At  once  it  may  be  said  that  the  first 
goal  to  be  sought  by  any  one  who  wishes  to  increase 
mental  control  is  improved  power  of  attention.  Exercise 
of  attention  in  itself  evidences  some  degree  of  mind- 
control  and  the  degree  of  nervous  disability  can  to  some 
extent  be  gauged  by  the  improvement  of  attentive  power 
as  evidenced  in  general  behaviour  and  conversation. 
This  wonderful  power  of  voluntary  and  involuntary  con- 
trol— the  function  of  inhibition — is  one  of  man's  crowning 
developments  ;  it  is  one  of  the  great  points  of  distinc- 
tion between  man  and  the  lower  animals  that  he  has  this 
faculty  of  forbidding  himself,  or  of  making  a  choice 
between  two  actions  so  strongly  developed.  To  strengthen 
inhibition,  to  augment  our  will-power  by  every  possible 
means  should  be  one  of  our  daily  tasks.  This  develop- 
ment should  always  be  one  of  the  leading  objects  of 
education,  and  the  training  of  the  will  should  play  a  much 


PRINCIPLES  OF  SELF-HELP  263 

greater  part  in  the  up -bringing  of  young  children  than  has 
hitherto  been  the  case.  Ability  to  make  a  decision  and 
maintain  it ;  the  power  to  follow  out  persistently  a  definite 
Kne  of  life  ;  the  power  to  lead  and  help  fellow-creatures — 
all  these  depend  ultimately  on  the  extent  to  which  one 
can  exercise  the  great  function  of  inhibition. 

From  the  practical  point  of  view,  one  finds  that  the 
best  way  of  strengthening  mental  control  is  to  make  a 
habit  of  exercising  inhibition  to  a  greater  or  less  extent 
every  day.  Indeed,  it  is  remarkable  what  great  benefit 
the  nerves  can  obtain  from  daily  exercise  of  self-control ; 
by  no  means  an  original  observation  or  a  new  thought, 
for  religious  systems  have  noted  the  importance  of 
exercising  inhibition  in  little  ways  in  the  building  up  of 
character.  Is  not  this  the  whole  practical  point  about 
"  self-denial  "  ?  And  self-denial  has  been  taught  by 
many  Churches  in  many  lands  to  be  a  great  factor  in  the 
progress  of  the  human  soul.  It  is  the  continued  exercise 
of  the  power  of  inhibition,  of  forbidding,  of  self-denial 
that  makes  so  strongly  for  the  regaining  of  control ; 
much  more  so  than  one  or  two  single  acts  of  great  self- 
denial  in  which  the  full  power  of  inhibition  have  been 
concentrated  on  one  great  deed,  as  it  were.  The  con- 
tinued practice  of  inhibition  and  of  little  self-denials 
steadily  strengthens  the  wiU,  and  therefore  steadily  helps 
the  individual  towards  the  longed-for  end  of  complete 
self-control ;  whereas  one  great  act  of  inhibition,  or 
self-denial,  by  its  very  intensity,  may  go  a  long  way 
towards  further  weakening  the  patient  and  exhausting 
his  nerve-strength.  The  mere  fact  of  occasionally  re- 
stricting some  habitual  pleasure — say,  smoking  less 
cigarettes  or  purchasing  a  new  dress — or  the  voluntary 
denial  of  various  good  things  the  world  has  to  offer,  goes 
a  long  way  towards  exercising  and  strengthening  the 
control  we  ought  to  have  over  our  thoughts,  words,  and 
deeds.  Of  all  things  the  best  exercise  for  increasing 
powers  of  both  attention  and  control  is  to  be  found  in 


264  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

the  practice  of  watching  one's  thoughts,  and  checking 
each  one  that  points  in  the  direction  of  surrender,  depres- 
sion, doubt,  anxiety  or  anger.  Every  thought  of  a  nega- 
tive kind  should  at  once  be  made  use  of  to  point  the  way 
towards  its  positive  counterpart.  A  persistent  habit  of 
seeing  the  bright  side  of  everything  ;  of  determinedly 
looking  for  the  silver  lining  no  matter  how  black  the  cloud 
will  be  found  invaluable  in  self-help. 

Fear  is  the  great  adversary  of  most  nervous  persons. 
Manifesting  in  a  thousand  guises,  choosing  anxiety  and 
worry  as  its  favourite  forms,  fear  haunts  many  through- 
out their  lives.  Anxiety  attacks,  sense  of  apprehension, 
worrying  over  trifles,  fearing  things  that  never  come  to 
pass  exhausts  energy  and  wears  down  health.  Unreason- 
able fear  about  the  common  possibilities  of  life  is  at  the 
bottom  of  much  impairment  of  nerve  strength  and  vitality. 
The  neurasthenic  is  essentially  a  person  preoccupied 
with  fear.  Often  enough  he  does  not  realize  the  extent  of 
his  enchainment,  and  only  after  careful  examination  of 
his  outlook  begins  to  understand  how  fear  has  held  him 
bound.  Where  there  is  fear  without  due  cause  sympa- 
thetic reasoning  helps  to  dismiss  the  troublesome  thoughts, 
but  one's  task  is  harder  where,  as  often  happens,  the 
nervous  person  can  point  to  some  definite  circumstance 
in  life  as  a  reasonable  basis  for  his  anxieties.  The  point 
here  is,  of  course,  that  the  abnormally  anxious  person 
fears  out  of  due  proportion.  In  other  words,  he  makes  a 
habit  of  anticipating  the  worst.  If  he  catches  cold  he 
expects  pneumonia  ;  if  he  has  a  pain  in  his  chest  after  a 
heavy  meal  he  fears  heart  trouble  rather  than  indigestion  ; 
if  a  friend  is  unwell  he  anticipates  the  funeral ;  if  his 
business  gives  a  little  trouble  he  is  haunted  by  dread  of 
its  collapse. 

As  a  rule,  individuals  show  a  curious  partiality  for 
particular  anxieties.  The  man  who  is  always  worrying 
about  his  health  may  take  the  success  of  his  career  for 
granted ;   the  woman  who  is  continually  anxious  about 


PRINCIPLES  OF  SELF-HELP  265 

her  future  takes  little  heed  for  her  health  and  so  on.  Cer- 
tainly many  whose  "  nerve  "  is  poor  are  troubled  by  fear 
at  every  turn,  and  their  lot  is  a  sad  one.  After  aU,  fear 
is  one  of  the  penalties  of  being  self-centred,  and  although 
impaired  nerve-health  may  lead  to  morbid  self-centring 
for  which  the  subject  cannot  be  held  directly  re- 
sponsible, nevertheless,  the  penalties  have  in  any  case 
to  be  paid.  To  get  away  from  self  is  a  troublesome  but 
essential  task  for  aU  suffering  from  nervous  disabilities. 
Their  malady  turns  their  thoughts  inwards  and  again 
inwards  to  dwell  on  the  myriad  discomforts  of  body  and 
mind  to  which  they  are  subject.  Recovery  of  health  can 
only  be  made  sure  when  they  can  succeed  in  looking  out- 
wards with  interest  to  the  world  about  them.  They 
have  to  get  out  of  their  tomb  of  desolation  in  which  self 
seeks  to  imprison  itself. 

The  way  to  the  goal  of  freedom  can  be  best  lighted  by 
a  sound  philosophy  of  life.  WUliam  James  realized  this 
when  he  boldly  recorded  his  belief  that  "  the  sovereign 
cure  for  worry  is  religious  faith."  ^  Certain  it  is  that  the 
man  or  woman  whose  faith  in  things  unseen  is  so  strong 
that  with  spiritual  eyes  they  can  pierce  through  the 
gloom  of  temporary  appearances  and  see  the  undying 
light  beyond  have  within  themselves  a  support  in  ilbiess 
that  nothing  else  can  equal  or  approach.  To  feel  safe,  to 
know  that  God  is  AU-in-All,  and  that  the  service  of  His 
creation  is  all  the  task  we  need  is  indeed  to  have  "  cast 
off  the  works  of  darkness,  and  put  on  the  armour  of 
Ught."  2 

^  Prof.  Wm.  James.  ^  Rom.  xdii.  12, 


PART  IV 
THE  BREAKDOWNS  OF  WAR 


CHAPTER  I 

THE   EFFECTS   OF   WAR  STEAIN 

Strain  of  modem  warfare — Shock  from  explosion — The  strain  of  battle 
— Brain  liable  to  both  mental  and  physical  assaults — Determining 
facts  of  war-strain  and  civilians — General  worries— Raids  and 
bombardment. 

AT  the  outbreak  of  the  great  war  it  was  confidently 
XjL  expected  by  neurologists  that  the  terrible  engines 
of  destruction  and  the  high  explosives  which  would  figure 
prominently  in  a  modern  conflict  would  place  an  over- 
whelming strain  on  many  combatants.  This  anticipa- 
tion was  quickly  realized  when  the  ambulance  trains 
began  to  bring  in  numbers  of  men  suffering  from  nerv- 
ous and  mental  derangements,  and  it  was  not  long  before 
the  public  became  familiarized  with  the  new  term  shell- 
shock  or  before  special  arrangements  were  made  for 
dealing  with  this  class  of  case.  One  realized,  indeed, 
that  the  mentally  wounded  would  require  as  much  atten- 
tion and  care  as  the  physically  injured.  In  the  actual 
area  of  hostilities  stresses  and  strains — both  physical 
and  mental — crowded  on  the  combatants  more  and 
more  furiously.  The  fatigue  of  service,  the  long  watch- 
ing in  the  trenches  by  day  and  by  night,  the  cunning 
and  remorseless  cruelty  of  the  enemy,  the  stress  of 
actual  engagement,  piled  up  a  burden  so  great  that  the 
individual  has  not  always  been  able  to  bear  it.  The 
noise  alone  is  sufficient  to  cause  such  vibrations  in  the 
brain  and  special  sense  organs  as  not  infrequently  to 
overwhelm  them  ;  shells  and  bombs,  mines  and  aerial 
torpedoes,  bursting  with  ceaseless  din,  have  combined  in 

269 


270  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

such  an  assault  of  sound  as  the  human  nervous  system 
has  never  before  been  asked  to  sustain. 

The  fact  that  explosions  have  featured  so  prominently 
in  war  conditions  producing  nervous  breakdown  has  led 
to  the  use  of  the  now  popular  term  "  shell-shock  "  to 
indicate  all  the  varieties  of  nerve  disturbance  thus  occa- 
sioned. It  should,  however,  be  clearly  understood  that 
many  cases  of  breakdown  are  not  really  instances  of 
sudden  shock  at  all,  but  represent  a  total  exhaustion  of 
the  nervous  system  following  a  period  of  strain.  Various 
other  terms  are  used  to  designate  these  mental  and  nerv- 
ous troubles,  but  there  do  not  appear  to  be  any  phrases 
so  clearly  indicative  of  the  issue  as  war-neurasthenia,  and 
war-hysteria.  War-strain,  or  psycho-neurosis  of  war, 
are  also  terms  in  common  use,  but  would  appear  to  have 
no  special  advantages.  All  these  terms  indicate  the 
varied  expressions  of  mental  disturbance  and  nervous 
breakdown  particularly  associated  with  stresses  of  war 
conditions. 

Studying  in  detaD.  the  special  features  of  shell-shock 
clearer  understanding  is  necessary  of  the  fact  that  the 
bursting  of  a  shell  is  often  by  no  means  the  sole  cause  of 
the  collapse  ;  the  exhaustion  may  be — often  is — simply 
the  last  straw  in  breaking  the  camel's  back.  It  frequently 
happens  that  the  neurasthenic  state  immediately  follows 
what  appears  to  be  a  comparatively  small  shock ;  in  these 
cases  the  exhaustion  has  come  at  the  end  of  a  series  of 
events  tending  to  upset  the  balance  between  mind  and 
body.  Men  in  the  front  Imes  of  an  army  are  frequently  kept 
in  a  state  of  nervous  tension  for  days  at  a  time.  Hunger, 
exposure,  fatigue,  and  want  of  sleep  aU  tend  to  sap  the 
nervous  energy  whilst  strong  emotional  waves  disturb 
mental  calm.  Anticipation  of  coming  events,  fear  called 
out  by  near  explosions,  horror  and  distress  at  the  wound- 
ing or  death  of  comrades,  load  the  mind  heavily,  but 
may  just  be  supportable  ;  yet  they  stretch  the  nerves  to 
such  a  point  that  very  little  extra  strain  causes  a  break. 


THE  EFFECTS  OF  WAR  STRAIN  271 

On  the  other  hand,  it  is  quite  true  that  an  explosion  of 
itself  may  be  sufficient  to  produce  severe  shell-shock. 
High  explosives  produce  such  a  tremendous  disturbance 
that  the  nervous  system  may  be  suddenly  exhausted 
apart  from  any  wounding,  and  even  where  the  sufferer 
is  in  a  good  state  of  physical  and  mental  health.  The 
terrific  noise,  tremendous  concussion,  and  the  vast  up- 
heaval of  ground — victims  of  the  explosion  being  thrown 
headlong  many  yards  away  or  buried  where  they  stand — 
present  an  appalling  combination  of  nerve-breaking 
conditions.  Whilst  here  again  the  emotional  factor 
constantly  operates  and  dreadful  sights  of  mutilation 
and  slaughter  play  their  part. 

To  understand  shell-shock  one  must  recall  the  peculiar 
features  of  brain  action  and  its  characteristic  concern 
with  two  phases  of  life.  As  we  have  seen,  the  brain  is 
remarkable  for  functioning  in  two  spheres  ;  on  the  one 
hand  being  the  organ  for  the  regulation  of  physical 
activity,  and  on  the  other  the  medium  for  the  harmoni- 
ous co-ordination  of  these  two  kinds  of  brain  activity  ; 
it  is  compounded  of  a  psychological  as  well  as  of  a  physio- 
logical factor,  and  for  the  same  reason  disturbance  of 
mental  balance,  that  is  weakening  of  nerve,  may  be 
initiated  from  both  sides.  All  our  ordinary  experiences 
of  life  are  concerned  with  brain  action  in  regard  to  both 
thought  and  activity.  Whatever  we  do  we  live  this 
double  mind-matter  life  ;  always  we  live  this  double 
life  of  thought  and  movement,  and  there  is  ceaseless 
action  and  reaction  between  mind  and  body.  Whatever 
is  conceived  in  thought  depends  on  the  brain  for  its 
material  accomplishment  ;  whilst  on  the  other  hand, 
activities  in  body  constantly  affect  mental  outlook. 
These  functional  peculiarities  of  the  brain  and  its  depen- 
dent nerve-centres  particularly  predispose  the  nervous 
system  to  shock  and  strain,  for  it  is  quite  clear  that  they 
must  come  in  for  a  double  share  of  stress.  The  brain  is 
the  only  organ  of  the  body  that  does  work  both  mental 


272  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

and  physical.  Compare  it  with  the  lungs,  for  example  ; 
one  can  injure  these  by  some  direct  physical  assault — 
in  war  one  can  drive  a  bayonet  or  bullet  into  them,  one 
can  reach  them  by  poisoned  gas — but  one  cannot  worry 
them  directly  by  emotional  strain.  On  the  other  hand, 
one  can  not  only  injure  the  brain  physically,  but  in  addi- 
tion to  material  damage  or  concussion  one  can  harass  it 
by  mental  worry  at  the  same  time.  Indeed,  frequently  the 
conditions  of  a  head- wound  are  such  that  the  brain  is  not 
only  shaken  up,  but  is  strained  by  the  anxiety,  excitement, 
and  general  emotional  stress  attendant  on  the  circum- 
stances under  which  the  wound  was  received.  All  organs 
of  the  body  other  than  the  brain  can  only  be  directly 
assaulted  by  material  means.  The  brain  is  subject  to 
both  mental  and  physical  blows  ;  even  under  favour- 
able material  conditions  it  is  continually  subject  to 
damage  from  emotional  shocks.  Is  it  not  clear  that  a 
man  under  bombardment  may  come  through  with  his 
entire  physical  system  apparently  undamaged,  but  a  few 
hours  afterwards  find  that  he  is  seriously  incapacitated 
through  disorder  of  his  nervous  system  which  has  re- 
sulted from  the  mental  strain  he  has  undergone  and  not 
from  material  injury  ?  The  flying  fragments  of  bursting 
bombs  did  not  damage  him  directly,  but  the  shock  of  the 
attack,  the  horror  of  seeing  others  struck,  the  fear  about 
self,  friends,  and  comrades,  anticipation  of  more  intense 
bombardment,  near  explosions  and  the  excitement  of 
battle,  have  combined  to  produce  a  volume  of  mental 
stress  that  has  proved  too  much  for  his  nervous  system. 
Even  where  the  breakdown  has  apparently  occurred  as 
the  result  of  one  big  explosion,  the  psychological  factor 
commonly  determines  the  resulting  nerve  disturbance. 
Often  it  is  a  question  of  acute  anxiety,  horror,  or  antici- 
pation sufficing  to  overcome  the  nervous  system  in  face 
of  simultaneous  physical  shock  ;  at  other  times  it  is  a 
matter  of  one  final  mental  strain  acting  as  the  last  straw. 
In  considering  this  sudden  loss  of  nerve-balance,  it 


THE  EFFECTS  OF  WAR  STRAIN  273 

must  be  realized  how  much  the  individual  is  always 
strained  before  the  final  shock  hj  the  exercise  of  his  normal 
control  over  emotional  states.  Up  to  a  point  he  manages 
to  keep  a  firm  hold  over  himself,  to  crush  down  his  fears 
and  anticipations.  Be  it  noted,  this  control  is  often 
maintained  for  a  short  while  after  the  final  catastrophe  ; 
long  enough,  indeed,  for  the  shocked  soldier  to  make 
some  attempt  to  help  himself  out  of  difficulties.  There  is, 
therefore,  often  a  definite  period  between  shell-explosion 
and  resulting  nerve-collapse.  The  explanation  of  this  is 
that  the  intensity  of  self-preservation  so  strongly  rooted 
in  every  human  body  operates  to  keep  up  control  when 
otherwise  it  would  be  lost  by  conscious  will.  This  power- 
ful instinct  takes  charge  for  the  time  being  and  forces 
the  individual  to  act  in  spite  of  the  shock  sustained  until 
he  has  secured  safety.  Then  it  lets  go,  and,  left  to  his 
own  conscious  control,  the  sufferer  collapses. 

There  is  yet  this  further  consideration  that  whatever 
be  the  actual  happening  of  series  of  events  that  finally 
determines  breakdown  on  the  field  of  battle,  the  catas- 
trophe is  enormously  favoured  by  certain  predisposing 
conditions.  So  much  so,  indeed,  that  one  is  tempted  to 
beheve  that  a  complete  record  of  the  past  life  of  each 
man  who  suffers  from  a  war  neurosis  would  certainly 
reveal  the  occurrence  of  one  or  other  of  these.  Certain  it 
is  that  there  has  been  individual  or  family  tendency  to 
nervous  instability  in  a  great  many  instances  of  shock  or 
similar  states.  Predisposition  to  nervous  disorder  is  un- 
doubtedly an  important  factor  in  the  chain  of  circum- 
stances which  culminates  in  these  maladies .  Often  enough, 
the  inherent  tendency  to  disturbance  of  balance  between 
mind  and  brain  is  a  constitutional  matter,  but  where 
a  man  born  apparently  with  a  healthy  nervous  mechanism 
has  for  some  reason  broken  down  in  civil  life  years  before 
he  suffered  the  strange  experiences  of  war,  this  earlier 
breakdown  has  left  its  mark  in  such  a  way  as  to  make 
him  an  easier  victim  to  war  strain.     In  addition  to  these 


274  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

two  important  predisposing  conditions — constitutional 
or  acquired  nerve  weakness — intemperate  habits  or 
previous  injury  to  the  head,  particularly  where  con- 
cussion of  the  brain  has  resulted,  must  certainly  weaken 
the  natural  defences  against  shock  and  stress  ;  also  a 
taint  of  insanity  or  epilepsy  in  a  family  seems  to  predis- 
pose the  members  thereof  to  the  neuroses  of  war.  Yet 
again,  local  disabihties.  even  of  a  small  order,  especially 
those  affecting  the  special  senses  or  limbs,  not  infre- 
quently influence  the  character  of  local  nervous  mani- 
festations resulting  from  shock  and  strain ;  whilst 
habitual  indulgence  in  tobacco  certainly  opens  the  way 
to  the  ready  development  of  certain  nervous  symptoms, 
notably  that  group  associated  with  "  soldier's  heart."  Of 
course,  on  the  field  of  battle  itself,  hunger,  privation,  and 
the  debilitating  effects  of  poisoned  gas  help  to  lower  nerve 
resistance. 

Again,  the  question  of  war-strain  has  affected  the 
nation  in  its  reactions  on  civilians.  The  long  struggle 
has  reacted  disastrously  on  many  in  civilian  life,  although 
it  must  be  said  at  once  that  in  this  country  at  any  rate 
civilian  nerves  have,  on  the  whole,  borne  this  strain  with 
wonderful  stoicism.  The  shock  of  the  outbreak  was  very 
great,  and  the  succession  of  events  which  plunged  us 
from  peace  into  horror  was  bewilderingly  rapid.  It  is  a 
tribute  to  the  stabihty  of  British  nerve  that  at  that  time 
cases  of  sudden  breakdown  were  few  and  far  between  ; 
the  strain  at  home  has  been  chiefly  mental,  varying  from 
the  sudden  shock  of  receiving  bad  news  to  the  dreary- 
watching  and  waiting  that  over-strained  even  the 
strongest.  Nervous  breakdowns  attributable  to  war- 
strain  there  have  been,  but  it  is  a  fact  that  there  has  been 
no  serious  increase  of  mental  or  nervous  illnesses  amongst 
the  civilian  population  in  spite  of  distressing  alarms, 
disappointments,  and  local  bombardments  that  have 
been  suffered. 

In  no  belligerent  country  has  the  civilian  population 


THE  EFFECTS  OF  WAR  STRAIN  275 

entirely  escaped  the  graver  consequences  of  war-strain. 
All  wars  necessarily  throw  an  added,  stress  on  the  nerves 
of  the  people  at  large  ;  thoughts  of  dear  ones  at  the 
front,  anxieties  about  general  developments,  financial 
worries  and  the  inevitably  distressing  effects  of  war-time 
conditions  always  react  on  those  left  at  home.  But  when 
the  conditions  of  warfare  are  such  that  the  army  is  the 
nation  and  the  battle-front  is  from  time  to  time  carried  to 
the  heart  of  big  cities  and  to  the  very  threshold  of  the 
citizens,  the  stress  becomes  very  great  for  many  indi- 
viduals and  unbearable  for  some  of  nervous  tempera- 
ment. Thus,  not  only  has  the  Great  War  been  pro- 
ductive of  nervous  breakdowns  that  would  probably 
not  have  occurred  otherwise,  but  it  renewed  dis- 
orders that  had  been  remedied,  and  developed  latent 
weaknesses  in  not  a  few  nervous  systems.  The  ups  and 
downs  of  the  long  struggle  were  accompanied  by  corre- 
sponding waves  of  emotion  in  the  nation  as  a  whole, 
and  each  wave  told  most  heavily  on  those  of  weakest 
nerve.  In  addition,  regulations  and  inconveniences  which 
never  previously  hampered  people  in  this  country  pro- 
duced a  sense  of  uncertainty  and  apprehension  that  again 
was  particularly  emphasized  in  those  constitutionally 
predisposed  to  neurasthenic  conditions.  And  yet  further, 
it  cannot  be  doubted  that  unaccustomed  restrictions 
and  modifications  of  diet  played  a  part  in  debilitating 
people's  nerve  tissues.  The  brain  requires  plenty  of  fat 
for  its  physical  sustenance,  and  fat  was  one  of  the  com- 
modities that  was  difficult  to  obtain.  Raids  by  sea  and 
air,  in  their  turn,  augmented  the  burden  thrown  on  the 
nation's  nerves  ;  but  although  not  a  few  individuals 
suffered  thereby,  it  is  equally  true  that  the  national  nerve 
as  a  whole  was  strengthened  rather  than  otherwise  by 
the  experiences  of  red-hot  war  in  our  midst. 

The  features  of  neurasthenic  and  similar  conditions 
amongst  civilians  either  attributable  to,  or  aggravated 
by,  war  strain  have  not  differed  as  a  rule  from  the  ordinary 


276  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

breakdown  of  peace  time,  with  the  exception  of  a  few 
instances  where  complete  mental  unbalance  occmTed, 
and  stricken  persons  became  deluded  into  the  false  belief 
that  they  were  pursued  by  spies,  or  suspected  of  spying, 
or  being  persecuted  by  the  Government  in  various 
mysterious  ways,  or  that  they  were  being  burdened  with 
serious  responsibilities  in  regard  to  the  war.  On  the 
other  hand,  where  breakdowns  occurred  primarily  as  the 
result  of  naval  or  aerial  bombardment,  the  resulting 
conditions  in  many  instances  resembled  those  of  the 
shell-shock  of  the  battlefield.  After  all,  the  conditions 
of  bombardment  with  the  shock  of  explosions,  the 
ear-splitting  crashes,  the  emotional  strain,  and  only  too 
often  the  terrible  sights  are  the  same,  and  must  react 
on  human  beings  in  the  same  way,  whether  they  occur  in 
an  actual  battle  or,  say,  during  an  air-raid,  and  so  it  is 
that  after  bombardments  civilians  suffered  from  such 
things  as  loss  of  voice,  paralysis,  persistently  rapid 
heart-beat,  sleeplessness,  terrifying  dreams,  trembhngs, 
mental  depression,  and  digestive  disturbances.  Still,  there 
is  no  doubt  that  the  extraordinary  adaptability  of  the 
human  system  enables  people  to  get  used  to  even  such 
experiences  as  bombardment  from  the  air,  and,  so  far 
as  can  be  judged,  the  general  effects  on  the  nervous  system 
of  dropping  bombs  was  not  so  severe  as  in  the  earlier  days 
of  raiding,  excepting  in  the  case  of  those  immediately 
concussed  by  explosions. 


CHAPTER  II 

SHELL-SHOCK 

The  wounded  in  mind — No  new  disease — A  convenient  term — Battle- 
field breakdown — Characteristics  of  war-neurasthenia — Typical 
examples — Mental  shock  and  its  consequences — Paralysis — Other 
limitations  of  movement — Astasia- abasia — Dumbness — Blindness — 
Deafness— Fui'ther  illustrations — Mental  breakdown — War  hysteria 
— Psychological  basis  of  shell-shock — The  outlook  in  war-break- 
downs. 

NERVOUS  disorders  due  to  war  strain  do  not  differ 
essentially  from  those  occurring  in  the  breakdowns 
of  ordinary  civilian  Ufe.  Examples  of  the  neurasthenic 
state  in  its  many  phases,  of  hysteria,  and  of  serious  mental 
derangement  are  frequent  enough  as  consequences  of 
war-time  stresses,  and  so  it  may  be  said  at  once  that, 
whilst  the  term  shell-shock  has  been  made  convenient  by 
usage,  there  is  really  no  new  nor  special  nervous  dis- 
tm^bance  for  which  such  a  novel  name  is  required.  As 
remarked  in  the  last  chapter,  the  actual  shock  of  an  ex- 
plosion is  often  merely  the  "  last  straw  "  in  a  series  of 
events  straining  the  mind  and  nervous  system  ;  and  the 
resulting  breakdown  often  has  no  features  associated 
with  the  particular  shock  which  finally  precipitated  the 
illness.  On  the  other  hand,  it  is  quite  true  that  an  explo- 
sion may  be  the  primary  as  well  as  the  determining  event, 
and  the  resulting  nervous  disorder  may  in  its  character- 
istics bear  some  witness  to  the  occasion  of  its  origin.  For 
the  rest,  the  observations  made  in  regard  to  the  forms  of 
nervous  breakdown  and  the  ways  in  which  this  disaster 
is  commonly  made  manifest,  apply  equally  well  here.^ 
Proceeding  to  the  study  of  the  usual  appearances  of 

1  Cf.  Part  II.,  Chap.  1. 

277 


278  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

battlefield  breakdown,  it  must  be  borne  in  mind  that  the 
state  of  things  found  near  the  firing  line  differs  consider- 
ably from  that  observed  in  the  nearer  base  hospitals,  and 
still  more  from  that  seen  in  the  military  institutions  at 
home.  There  Mdll,  however,  be  no  advantage  in  confining 
our  attention  to  cases  in  which  there  is  a  definite  connec- 
tion between  nervous  collapse  and  the  explosion  of  a 
shell,  bomb,  or  mine — ^true  shell-shock  ;  it  will,  indeed,  be 
more  convenient  to  review  widely,  and  without  immediate 
attempt  at  close  analysis,  the  general  manifestations  of 
these  breakdowns.  It  has  already  been  said  that  the 
neuroses  of  war  present  the  same  features  as  the  break- 
downs of  civil  life  ;  particularly  are  there  very  close  re- 
semblances between  them  and  the  nervous  maladies  with 
which  we  are  familiar  as  the  result  of  railway  disasters, 
accidents  with  machinery,  earthquakes,  and  similar 
calamities.  Certainly  the  symptoms  are  often  influenced 
and  associated  with  war  happenings,  and  especially  so 
in  regard  to  mental  disturbances,  but  the  fact  remains 
that  we  have  not  here  to  face  any  new  kinds  of  disease  ; 
a  circumstance  that  has  made  our  task  in  treatment 
somewhat  less  difficult. 

Where  nervous  disorder  occurs  in  men  subject  to  the 
continual  strain  of  modern  warfare,  headache,  sleep 
disturbed  by  nightmares,  neuralgic  pains,  haunting 
thoughts,  indigestion  and  sense  of  fatigue  in  mind  and 
body,  gradually  undermine  strength  and  impair  self- 
confidence.  In  civil  life  the  over-worked  individual  has 
his  sleep  spoiled  by  wakefulness,  and  muddled  dreams 
about  things  he  has  been  occupied  with.  In  the  neuras- 
thenia of  war  these  dreams  become  hideous  nightmares 
in  which,  with  vivid  detail,  gruesome  experiences  of  battle 
are  lived  through  again  and  yet  again.  The  more  terrible 
particular  experiences  have  been,  the  more  nerve-racking 
in  view  of  associations  with  personal  feelings — the  loss 
or  mutilation  of  friends,  for  example — ^the  deeper  the 
imprint  on  the  receptive  mind,  and  the  more  graphic  and 


SHELL-SHOCK  279 

tormenting  the  subsequent  reproduction  in  the  watches 
of  the  night.  Similarlj^  special  conditions  commonly 
accentuate  particular  symptoms,  and  so  lend  a  character 
to  neurasthenic  states  resulting  from  the  strain  of  active 
service  that  superficially  distinguishes  them  from  the 
nervous  exhaustion  of  civil  life. 

The  sort  of  experience  that  has  so  often  led  to  war 
neurasthenia  is  well  exempUfied  by  the  following  history. 
An  officer  who  had  been  through  the  hardships  of  a  long 
retreat  following  eight  or  ten  weeks  of  continued  fighting 
came  through  this  ordeal  without  injury.  Then  his  luck 
deserted  him,  and  he  found  himself  left  badly  injured  in 
a  trench  with  only  wounded  men  around  him.  There  he 
lay  for  many  hours  with  shells  dropping  round  him 
sometimes  near  and  sometimes  far.  Exhausted  and 
in  pain,  expecting  every  minute  to  be  his  last,  he  felt 
certain  that  if  not  put  out  of  his  miseries  by  a  shell 
he  would  be  killed  by  the  attacking  enemy  or  left  in  a  sort 
of  no-man's-land  to  die  of  starvation.  However,  as  things 
happened,  a  counter-attack  brought  him  help,  and  he 
was  carried  back  to  safety.  Neurasthenia  resulted,  and 
for  weeks  and  weeks  this  victim  of  war  stress  suffered 
from  broken  sleep  with  terrifying  dreams,  and  was  with- 
out mental  or  physical  energy.  In  addition,  he  was 
frequently  obsessed  by  the  false  sense  of  shells  dropping 
round  him.  Although,  under  systematic  treatment,  he 
ultimately  recovered  and  returned  to  active  service, 
he  was  for  a  long  time  incapacitated  by  inability  to 
sustain  any  mental  or  physical  effort,  irritabihty,  feehngs 
of  apprehension,  and  involuntary  remembrances  of  his 
experiences  whilst  lying  wounded. 

Such  an  experience  may  be  compared  with  that  of 
another  officer  who  was  suddenly  knocked  over  by  the 
explosion  of  a  shell  close  by  which  fortunately  caused 
neither  physical  injury  nor  loss  of  consciousness.  In- 
deed, he  was  able  to  get  up  and  continue  his  duties. 
Nevertheless,  the  shock  had  told  upon  his  nervous  system, 


280  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

and  some  hours  later  when  fatigue  and  hunger  had 
further  strained  his  nervous  system  he  became  mentally 
confused,  and  when  given  an  order  by  a  superior  officer 
was  unable  to  grasp  its  meaning  to  execute  it.  Neuras- 
thenia developed  just  as  in  the  preceding  instance. 
Exhaustion,  headache,  disturbed  sleep,  and  extreme  sen- 
sitiveness of  the  whole  nervous  system  produced  incapacity 
lasting  for  months.  Over  and  beyond  the  onset  of  a  readily 
recognizable  neurasthenic  state,  with  its  attendant  symp- 
toms, there  have  occurred  quite  commonly  a  series  of 
disabilities  resultmg  in  the  main  from  mental  impressions. 
Particularly  so  where  the  breakdown  has  been  finally  deter- 
mined by  the  shock  of  an  explosion.  To  be  blown  up  by  a 
shell,  mine  or  bomb  is,  indeed,  a  terrific  experience.  The 
general  upheaval,  the  appalling  noise,  the  physical  concus- 
sion and  consequences  such  as  being  hurled  through  the  air 
or  buried  in  debris — all  these  things  occurrmg  at  a  time  of 
mental  strain — ^result  in  far-reaching  disorder  of  nervous 
function.  Thus  it  is  that  after  such  experiences  men  are 
found  unconscious,  or  mentally  confused  ;  deaf,  blind, 
dumb,  or  paralysed  ;  sometimes  bereaved  of  memory  ; 
sometimes  gibbering  insanely.  The  paralyses,  distortions, 
and  special  sense  distm^bances  of  the  shell-shocked  are 
so  numerous  in  manifestation,  and  so  varied  in  combina- 
tion, that  akeady  a  large  descriptive  literature  has  accu- 
mulated in  regard  thereto.  Commonly  loss  of  power  is 
limited  to  one  or  two  limbs,  and  but  seldom  paralyses 
the  whole  body.  Often,  indeed,  in  place  of  complete  loss 
of  movement  there  is  weakness  with  irregular  movements 
of  the  limbs  which  proceeds  outside  the  control  of  the 
sufferer.  Again,  it  is  not  uncommon  to  find  lessened 
ability  to  co-ordinate  the  various  movements  of  the  body ; 
when  this  is  so  there  may  be  no  difficulty  in  actually 
moving  arms  or  legs,  but  the  victim  thereof  is  unable  to 
use  his  limbs  in  a  steady  and  harmonious  manner.  Where 
these  disorders  chiefly  affect  the  lower  extremities  they 
are,  of  course,  manifested  by  peculiarities  of  gait.    These 


SHELL-SHOCK  281 

vary  from  lameness  to  complete  collapse  of  the  whole 
muscular  mechanism  used  in  walking. 

Inability  to  walk  properly  is,  indeed,  a  common  result 
of  shell-shock  and,  apart  from  the  more  common  phases 
just  indicated,  some  singular  abnormalities  have  been 
observed,  such  as  where  men  have  for  some  weeks  been 
doubled  up  Hke  those  old  labourers  one  sometimes  sees 
working  in  the  streets  of  country  villages.  Fortunately 
for  them,  those  thus  afflicted  are  usually  able  to  lie  in 
their  beds  comfortably  and  straight.  It  is  when  they  get 
up  and  try  to  walk  that  their  backs  become  bent  and 
painful.  Then  there  is  the  remarkable  condition  known 
as  astasia-abasia,  in  which  there  is  ability  to  carry  out 
movements  of  arms  or  legs  easily  when  Ijdng  down,  but 
complete  failure  to  control  limbs  when  standing  or  walk- 
ing is  attempted.  A  good  description  of  this  disorder 
as  it  appears  on  the  battlefield  has  been  given  by  IMM. 
Roussy  and  Lhermitte,  two  weU-known  French  obser- 
vers, in  the  follomng  terms  :  "It  commonly  occurs  in  a 
man  who  has  been  thrown  to  the  ground  more  or  less 
violently,  and  who  has  rolled  into  a  trench  or  hollow. 
He  has  sometimes  been  able  to  get  back  to  the  first-aid 
post  either  by  laborious  walking  or  by  crawling  along 
the  ground.  By  the  time  he  gets  to  the  ambulance  he  is 
quite  unable  to  walk.  When  he  is  examined  lying  down 
he  exhibits  no  elementary  motor  disorders  ;  all  move- 
ments, muscular  power  and  tendon,  osseous  and  cutane- 
ous reflexes  are  normal.  If  placed  in  the  upright  position 
he  either  collapses  on  his  flaccid  lower  limbs  or  the  latter 
are  shaken  by  a  rapid  tremor  which  ends  in  an  indefinite 
treading  movement.  When  told  to  walk,  his  Hmbs  are 
incapable  of  action,  and  in  spite  of  an  obvious  efiort  his 
legs  are  quite  unable  to  execute  a  voluntary  movement. 
He  is  unable  to  walk,  even  with  the  aid  of  two  sticks  ;  the 
limbs  are  dragged  along  inertly,  as  in  true  paraplegia."^ 

1  Dr.  G.  Roussy  and  M.  J.  Lhermitte,  The  Psycho-neuroses  oj  War, 
pp.  40,  41. 


282  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

Sometimes  these  disabilities,  particularly  where  there 
is  complete  loss  of  power  in  a  limb,  are  due  to  some  actual 
damage  to  the  nervous  system,  so  that  either  through  an 
injury  to  the  brain  or  spinal  cord,  or  through  the  severing 
of  a  nerve  trunk  connecting  the  limbs  to  the  central 
nervous  system,  there  is  a  complete  cutting  off  of  control. 
But  apart  from  these  organic  injuries,  the  study  of  which 
finds  no  proper  place  here,  there  have  been  a  far  greater 
number  of  instances  in  which  the  disorders  of  movement 
have  been  entirely  functional  in  nature.  That  is  to  say, 
they  come  within  the  category  of  those  disturbances  of 
nervous  function  which  in  discussing  the  psycho-neurosis 
of  civilian  life  we  classify  under  the  comprehensive  term 
of  hysteria.  They  are,  therefore,  conditions  brought  about 
by  the  action  of  a  powerful  suggestion  in  individuals 
rendered  susceptible  to  mental  impressions  by  emotional 
stress. 

In  the  same  order  come  those  numerous  disturbances 
of  speech,  sight  and  hearing  that  have  become  familiar 
to  the  public  through  various  descriptions  and  para- 
graphs in  the  daily  press,  apart  from  an  increasing  semi- 
popular  literature  on  the  subject.  Dumbness  has  been 
extremely  common  as  a  result  of  shell-shock.  Every  one 
knows  that  acute  emotional  stress  may  deprive  an  indi- 
vidual of  the  power  of  speech.  Sometimes  the  mere 
shock  of  being  blown  up  is  sufficient  to  take  away  control 
of  vocal  organs  ;  sometimes,  added  to  the  shock,  there  is 
a  strong  self-suggestion  that  the  voice  has  been  lost,  con- 
veyed to  the  stricken  man  by  his  sense  of  incapacity  to 
collect  his  faculties.  Where  there  is  a  strong  suggestion 
of  this  kind  recovery  of  speech  is  usually  deferred  longer 
than  where  the  dumbness  is  primarily  due  to  shock. 
For  the  time  being  there  is  complete  inability  to  use 
the  muscles  of  the  larynx.  Moreover,  the  idea  of 
paralysed  vocal  organs  is  usuaEy  so  strong  that  there  is 
inability  even  to  whisper,  although  whispering  has  noth- 
ing to  do  with  the  vocal  cords,  but  is  carried  out  by  teeth, 


SHELL-SHOCK  283 

lips,  and  tongue  alone.  In  many  cases  there  appears  to 
be  great  impairment  of  the  power  to  move  the  tongue 
properly  when  it  is  a  question  of  wishing  to  speak,  although 
the  difficulty  does  not  persist  with  the  part  itself.  In- 
stead of  complete  loss  of  speech,  it  sometimes  happens 
that  stammering  occurs.  When  this  is  so  we  find  many 
personal  peculiarities  with  regard  to  the  stammerer,  just 
as  is  the  case  with  stammerers  in  civil  life. 

The  blindness  of  shell-shock  at  first  sight  seems  even 
more  remarkable  than  the  paralysis  or  other  disabilities, 
in  view  of  the  fact  that  it  occurs  so  often  where  there  is 
absolutely  no  damage  to  the  eyes  or  optic  nerve,  and  is 
recovered  from  time  and  again  with  such  dramatic 
suddenness.  Commonly  the  sufferer  from  this  form  of 
war  hysteria  keeps  the  eyelids  closed,  and  behind  them 
the  eyeballs  rolled  well  upwards  ;  a  process  of  self- 
suggestion  initiated  by  darkness  following  an  explosion 
or  aggravated  by  some  slight  muscular  trouble,  such 
as  dust  blown  into  the  eyes,  is  often  responsible  for  the 
inability  to  see.  Be  it  noted,  that  the  blindness  is  quite 
genuine  and  the  shell-shocked  patient  behaves  quite 
differently  from  the  man  who  is  malingering. 

Deafness  in  one  or  both  ears  is  another  result  of  shell- 
shock  often  observed.  Sometimes  it  is  very  persistent 
and  its  association  with  actual  damage  to  the  structure 
of  the  ear  may  make  it  difficult  to  determine  whether  the 
inability  to  hear  is  functional  or  irretrievable.  As  wiU 
be  seen,  when  reviewing  the  future  of  the  shell-shocked, 
whilst  dumbness  is  one  of  the  results  most  readily  treated, 
deafness  is  extremely  resistant  to  treatment.  In  one  sense 
it  is  fortunate  that  the  deafness  of  shell-shock  is  very 
often  associated  with  inability  to  speak,  because  the 
rehef  of  the  latter  encourages  the  patient  to  assume  an 
attitude  of  mind  in  which  he  is  expectant  of  being  freed 
from  the  former.  As  the  cure  of  these  cases  must  always 
in  principle  be  psychological  there  is  here  an  obvious 
factor  operating  in  favour  of  recovery. 


284  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

The  following  notes  illustrate  how  some  of  the  common 
results  of  shell-shock  of  the  kind  just  discussed  produce 
disablement.  Sometimes  shell-shock  results  in  a  combina- 
tion of  the  neurasthenic  state  with  one  of  the  more  defi- 
nite local  limitations  of  action,  as  shown  by  the  case  of  a 
gunner  who  broke  down  after  having  been  blown  up  and 
buried  no  less  than  three  times.  Here  the  symptoms  were 
severe  headache,  broken  sleep,  with  terrifying  dreams  ; 
general  nervousness  ;  depression  ;  want  of  appetite  ; 
pains  in  the  legs ;  and  also  paralysis  of  the  left  arm. 
Under  appropriate  treatment  the  last-named  symptom 
disappeared  long  before  he  was  relieved  from  the  general 
neurasthenic  troubles.  Again,  a  non-commissioned 
officer  who  was  buried  by  the  explosion  of  a  big  shell 
became  deaf  and  lost  all  powers  in  the  right  lower  limb 
from  the  hip  downwards.  The  paralysis  was  accom- 
panied vv^ith  a  sense  of  burning  in  the  right  side  and  leg, 
whilst  disturbed  sleep,  headache  and  mental  confusion 
sufficiently  expressed  the  accompanying  neurasthenia. 

A  man  was  hit  in  the  back  by  a  fragment  of  bomb  just 
as  he  was  getting  out  of  a  trench  ;  he  fell  forward  and 
found  himself  paralysed  in  both  legs.  This  incapaci- 
tated him  for  a  long  time,  and  six  or  seven  months  after- 
wards he  was  only  able  to  get  about  with  the  aid  of  two 
sticks,  and  with  bent  back.  Another  man  who  was  buried 
by  shell  explosion  lost  consciousness  and  knew  nothing 
more  until  he  found  himself  in  a  dressing  station.  For 
some  hours  both  legs  were  completely  paralysed,  the 
power  to  use  them  then  returning  gradually.  Subse- 
quently, he  was  for  some  time  very  nervous,  sleeping 
badly,  troubled  with  nightmares,  and  suffering  from 
headache  and  mental  confusion. 

The  more  usual  combinations  of  physical  and  mental 
disabilities  following  shell-shock  and  war-strain  are  well 
illustrated  by  the  following  examples  :  A  young  private 
soldier  ivas  buried  in  a  trench  by  shell  explosion  three  or 
four  weeks  before  coming  under   observation.     He  had 


SHELL-SHOCK  285 

been  unconscious  for  some  time,  and  for  about  four 
days  subsequently  was  quite  unable  to  locate  himseK, 
as  he  had  lost  his  memory  for  recent  events.  For  a 
long  time  he  was  incapacitated  by  severe  headache, 
general  nervousness,  disturbed  sleep,  with  terrifying 
dreams  about  fighting  and  battlefield  experiences.  Noises 
disturbed  him  greatly,  producing  considerable  emotional 
disturbance  and  increasing  his  headache.  His  progress 
towards  recovery  was  seriously  incapacitated  by  the 
disturbance  due  to  an  air-raid.  A  man  who  was  struck 
by  a  bullet  on  the  right  temple  was  unconscious  for 
awhile,  but  soon  recovered  sufficiently  to  be  able  to  walk 
back  to  an  ambulance.  Subsequently  suffered  from 
great  nervousness  and  emotionalism,  disturbed  sleep 
with  nightmares,  headaches,  giddiness  and  depression. 
An  artilleryman  was  standing  in  a  gun  emplacement 
when  a  shell  exploded  and  buried  him.  When  dug  out 
he  was  found  to  be  unconscious  with  a  wound  on  the  left 
side  of  his  head.  On  regaining  consciousness  he  was 
dazed  and  trembled  continually.  This  condition,  evi- 
dently partly  due  to  concussion,  led  to  a  neurasthenic 
state  in  which  considerable  depression,  want  of  sleep, 
and  nightmares,  figured  prominently.  For  a  long  time 
he  was  very  emotional,  and  when  anything  occurred 
to  recall  his  experiences  became  anxious  in  manner,  per- 
spiring freely,  and  trembled  violently. 

An  infantryman  was  just  getting  out  of  a  trench  when 
a  fragment  of  a  bomb  hit  him  in  the  bach.  He  fell  forward, 
but  did  not  lose  consciousness.  His  legs  were  paralysed, 
and  he  dragged  himself  to  a  shell-hole  for  safety.  He  lay 
between  the  lines  for  about  three-quarters  of  an  hour,  and 
then  dragged  himself  about  a  mile  and  a  quarter  to  the 
fii'st-aid  post.  Dm^ing  this  time  he  was  hit  by  a  bullet. 
He  says  the  excitement  carried  him  through.  The  con- 
dition at  that  time  was  complete  paralysis  from  the  hips 
downwards,  so  that  he  was  quite  unable  to  move  his  legs  ; 
he  suffered  much  pain  in  hie  back,  very  bad  nights,  and 


286  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

severe  headaches.  The  paralysis  lasted  some  weeks, 
and  was  eventually  relieved  by  the  use  of  a  special  psycho- 
physical method.  In  another  instance  the  victim  was 
standing  on  the  firing  'platform  of  a  trench  when  a  shell 
exploded  immediately  in  front  of  the  parapet  behind 
which  he  was  standing.  The  result  of  this  was  that  he 
was  blown  off  the  shelf,  his  head  and  back  coming  forcibly 
in  contact  with  the  back  of  the  trench,  when  he  rebounded 
to  the  bottom  of  the  trench  just  in  time  to  receive  a  mass 
of  earth,  sand-bags,  and  other  things,  which  piled  them- 
selves up  and  half  buried  him.  When  rescued  he  was  in 
a  state  of  mental  confusion  and  unable  to  move.  For 
some  time  he  had  loss  of  power  in  legs,  no  capacity  for 
mental  or  physical  effort,  nightmares,  and  depression. 
Eventually  he  was  relieved  by  a  combined  treatment  of 
static  electricity,  conversational  suggestion  and  re- 
education. 

Sometimes  mental  symptoms  predominate  to  the  exclu- 
sion of  all  other  manifestations  of  shell-shock,  and  to  such 
an  extent  that  the  stricken  man  is  for  the  time  being  quite 
irresponsible  for  his  actions.  On  occasion  the  mental 
breakdown  is  accompanied  by  great  violent  and  maniacal 
outburst.  More  often  the  disturbance  is  of  an  emotional 
character  with  complete  loss  of  self-confidence,  severe 
depression,  and  loss  of  interest  in  everything.  Many 
shell-shocked  men  complain  merely  of  being  mentally 
confused,  sleeping  badly,  unable  to  maintain  attention, 
and  headache.  A  private  who  was  buried  several  times 
on  one  particular  day  eventually  lost  consciousness. 
Subsequently  was  very  emotional  and  had  bad  head- 
ache. Memory  of  the  strain  through  which  he  had  passed 
had  been  with  him  all  the  time,  and  wearing  him  down. 
Particularly  during  the  nightmares,  in  which  he  felt  as  if 
he  was  being  suffocated  by  something  pressing  closely 
upon  him.  The  latter  caused  great  disturbance  of  sleep 
with  struggling  and  loud  calls  for  help.  A  Canadian  who 
had   been    blown   up   and   left    buried   for   some   fiiteen 


SHELL-SHOCK  287 

minutes  did  not  immediately  collapse,  but  gradually 
broke  down  under  the  strain  of  shell-fire  on  subsequent 
days.  In  addition  to  a  neurasthenic  state  which  deve- 
loped he  was  very  weak  in  his  legs,  walking  with  struggling 
steps,  and  attacked  by  violent  trembling  whenever  he 
stood  still. 

It  is  not  difiScult  to  understand  how  a  long  period  of 
strain  culminated  by  a  specific  shock  should  produce  a 
condition  of  general  neurasthenia  with  symptoms  charac- 
teristic thereof,  nor  to  comprehend  that  an  explosion  may 
often  deprive  its  victim  of  speech,  sight,  hearing  and 
power  of  movement  for  the  time  ;  but  special  explana- 
tion is  needed  of  why  a  man  should  remain  dazed,  blind, 
dumb,  paralysed,  or  unable  to  walk  for  weeks  and  months 
afterwards.  We  want  to  know  what  impression  has  been 
made  on  the  nervous  system  that  should  make  it  suffer 
such  prolonged  disturbance.  Let  it  be  said  at  once  that 
this  riddle  can  only  be  read  correctly  in  the  light  thrown 
by  other  side-issues,  and  particularly  by  the  analysis  of 
the  basis  of  hysteria.^  In  the  first  instance  one  must 
recall  the  persistent  dreams  and  distressing  mental 
pictures  that  haunt  so  many  shell-shock  patients  for  a 
long  time,  and  reaKze  that  just  as  these  pictures  have 
been  so  firmly  impressed  on  conscious  thought  so  others 
have  become  imprinted  on  the  retina  of  the  mind,  although 
the  sufferer  is  not  conscious  of  this.  The  blindness,  deaf- 
ness, paralysis,  and  so  forth  express  outwardly  the  morbid 
ideas  that  have  thus  taken  root  in  subconsciousness.  It 
is  a  matter  of  the  fixation  of  the  morbid  idea  by  intense 
suggestion  at  a  moment  of  greatly  increased  suggestibility 
due  to  emotional  tension.  Self-control  is  weakened  and  the 
forceful  suggestion  given  ;  the  morbid  idea  accepted  in 
consciousness  then  becomes  "  buried  "  and  subsequently 
reacts  to  produce  disturbance  of  function.  Moreover,  it 
goes  on  reacting  in  this  way  until  it  can  either  be  dis- 
charged   by   explanation,    or    naturalized    by    counter- 

1  See  Part  II,  Chap.  V. 


288  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

suggestion.  If  the  paralysed  \'ictim  of  shell-shock  could 
retam  in  memory  the  occasion  which  produced  his  dis- 
ability it  would  not  be  so  difficult  to  free  him  from  it  ; 
but  the  more  deeply  it  has  been  buried  in  subconscious- 
ness the  more  resistant  his  symptoms. 

As  examples  of  the  sort  of  powerful  suggestion  that  is 
operative  at  a  time  of  acute  shell-shock  one  may  note  the 
pressure  exerted  on  limbs  by  falling  earth,  or  forceful 
closure  of  eyes  by  debris.  In  each  instance  at  the  moment 
of  crisis,  or  immediately  after,  the  stricken  man  finds 
himself  from  actual  force  of  circumstances  unable  to  move 
one  or  aU  his  limbs  ;  possibly  unable  to  open  his  eyes,  or 
if  he  does  open  them  finding  himself  in  pitch  darkness  ; 
perhaps  unable  to  hear.  Instantly  the  idea  flashes 
through  his  mind — so  quickly,  perhaps,  that  he  is  un- 
aware of  it — "I  am  paralysed" — "I  am  blind" — "I 
am  deaf."  After  rescue  his  memory  of  the  crisis  is  blurred 
or  lost,  but  the  effect  of  the  anxiety-reaction  remains. 
There  is  here  no  question  of  malingering.  The  victim  of 
shell-shock  is  overwhelmed  in  mind  and  unable  to  extri- 
cate himseK  from  the  psychological  maze  into  which  he 
has  been  suddenly  thrown.  It  would  scarcely  be  neces- 
sary to  say  this  were  it  not  for  the  fact  that  the  idea  of 
hysteria  is  stiU  associated  with  fraudulent  behaviour  by 
many  who  completely  misunderstand  the  basis  of  hysteri- 
cal troubles.  Even  among  medical  men  this  misconcep- 
tion is  sometimes  found,  particularly  is  there  failure  to 
realize  how  completely  resulting  disturbances,  paralysis, 
and  so  forth,  are  beyond  the  control  of  those  exhibiting 
them  when  it  is  found  that  collapse  occurs  from  the  re- 
calling to  mind  of  the  circumstances  originally  occa- 
sioning shell-shock.  But,  as  was  noted  in  our  survey  of 
the  emotions,  the  memory  of  an  emotion  may  cause 
just  as  much  physical  reaction  as  the  emotion  itself. 
Thus,  anything  that  recalls  circumstances  of  the  battle- 
field or  even  the  fact  of  military  service  may  be 
sufficient  to  bring  back  symptoms  that  had  disappeared 


SHELL-SHOCK  289 

under  treatment.  And  so  one  finds  that  the  sound  of 
anti-aircraft  guns  or  other  disturbing  noises,  news  from 
the  front,  or  even  the  receipt  of  an  official  document 
will  thoroughly  unnerve  men  who  have  been  previously 
making  good  progress. 

Loss  of  confidence,  lack  of  interest,  failure  of  elasticity, 
depression,  weakened  powers  of  will  and  attention — 
these  mental  disabilities  are  the  more  serious  of  the 
wounds  in  mind  caused  by  war  events.  The  paralyses, 
contractions  and  other  local  disturbances  commonly 
yield  to  treatment  without  great  difficulty — even  where 
resistant  it  is  commonly  found  that  measures  based  on 
a  proper  understanding  of  the  psychological  issues 
banish  these  consequences  of  shell-shock ;  but  such 
things  as  failure  of  will,  loss  of  self-confidence  and  depres- 
sion offer  much  greater  resistance  to  treatment,  and  often 
defy  one's  best  efforts  to  get  rid  of  them  quickly.  It  is, 
indeed,  a  serious  matter  that  for  a  long  time  to  come 
many  men  will  be  hampered  by  such  limitations  to 
greater  or  less  extent  ;  their  incapacity  depending  on  the 
stress  or  strain  of  work  they  may  take  up.  Nevertheless, 
in  spite  of  this  there  are  many  reasons  for  being  optimistic 
about  the  outlook  for  those  wounded  in  mind.  Catas- 
trophies  there  have  been  so  great  that  one  cannot 
reasonably  look  for  restoration  of  health  or  balance, 
but  such  are  very  much  in  the  minority  ;  everything 
goes  to  show  that  treatment  on  the  lines  indicated  when 
we  reviewed  our  methods  for  redressing  the  balance  suffices 
to  bring  back  nerve-health  ;  maybe  many  months  will 
sometimes  be  required  to  effect  this  happy  issue,  but 
there  is  no  reason  to  be  despondent  at  the  length  of  a 
"  cure  "  when  its  fulfilment  is  certain.  Always  in  nerv- 
ous maladies  treatment  through  mind  is  of  primary  im- 
portance, but  experience  shows  that,  if  possible,  it  has 
even  greater  potency  in  the  breakdowns  of  war  than  in 
those  of  civil  life. 

The  only  exception  to  this  optimistic  outlook  is  to  be 


290  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 

made  in  regard  to  breakdown  accompanied  by  actual 
organic  damage  to  brain  or  nervous  system  such  as 
permanently  to  impair  the  physical  mechanism  of  conduct 
and  reaction.  Otherwise  one  can  always  hope  with  due 
reason — even  where  there  is  dire  mental  derangement — 
that  time  and  perseverance  will  in  the  end  help  harmony 
to  resume  its  rightful  place. 


INDEX 


Accidents,  60,  63,  64,  75,  76 

Actors,  65 

Adolescence,  59,  107,  253,  et  seq. 

difficulties,  253,  254 

emotionalism,  255 

extravagancies,  253,  254 

suggestibility,  255 

the  flapper,  255,  256 
Africa,  6,  66,  67 
Agamemnon,  21 
Age,  and  nervous  breakdown,  77,  78 

old  age,  77 
Agoraphobia,  13,  111 
Air-raid,  276 
Alcohol,  72,  73 
American  negro,  77 
Analysis,  of  thought,  33 
Anaesthesia,  148 
Anger,  20,  21,  22 
Anthropophobia,  113 
Anxiety,  13,  19,  36,  37,  51,  et  seq., 

148,  264 
Aphonia,  142,  150,  151,  152,  282 
Aristocracy,  and  nervous  weakness, 

69 
Armstrong- Jones,  Sir  Robert,  M.D., 

47 
Artisans,  and  nervous  breakdown, 

62 
Astasia-abasia,  28,  142. 
Astrophobia,  114 
Attacks — 

hysterical,  143,  et  seq. 

nervous,  9,  35,  101,  260 

of  giddiness,  13,  98 

of  indigestion,  132 
At  the  End  of  the  Passage,  67 
Attentive  control,  260 
Austria,  and  inherited  nerve  weak- 
ness, 69 
Automatism,  148 
Automatic  writing,  161 
Automatic  speaking,  161 


Auto-intoxication,  71,  128 
Aviation,  4 

B 

Baber,  and  nervous  breakdown,  66 
Babinski,  Prof.,  19 

theory  of  hysteria,  144,  167,  168 
Bach,  family  of,  48 
Bacon — 

on  sleeplessness,  221 

on  fitness,  261 
Baths,  215,  216,  217 
Batophobia,  114 
Beethoven,  48 
Bismarck,  69 
Blindness,  280,  283 
Blushing,  14 

morbid,  14 
Borrow,  Chas.,  55 
Borderland,  85 
Bowel,  71,  131 
Brain  cells — - 

and  alcoholism,  73 

inherited  delicacy,  6 
Brain,  82 

wear  and  tear,  220,  221,  233 
Brain-work — 

good  for  the  nervous  system,  52 

and  adolescence,  59 
Brain-workers — 

and  nervous  breakdown,  60,  61 
Brain-storms,  9,  10,  12,  57 
Breakdown,  premature,  15 
British  Medical  Journal,  50,  66 
Brunton,    Sir    Lauder,    M.D.,    on 

worry  and  indigestion,  126 
Buddhism,  46,  47 
Burns,  Robert,  47 
Burr,  Dr.  Chas.,  34 

on  emotional  stress,  35 

on    racial    response    in    nervous 
breakdown,  77 
Business  man,  breakdown  of,  10 
Byron,  47 


291 


292  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 


c 


Caffeine,  72 

Calais,  Mary  Tudor  and,  24 

Casquet  neurasthenique,  91 

Catalepsy,  151 

Causes  of  nervous  breakdown,  17,  18 

Central  Europe,  tribes  of,  46,  47 

Charcot — 

and  the  hysteric,  146,  167 

and  the  neurasthenic,  90 
Character,  39 

Charles,    Sir    Havelock,    M.D.,    on 

nervous  breakdown  in  India,  66 

Chauffeurs,  and  nervous  breakdown, 

63 
Children,  12 

nervous,  12 
Childhood,  240,  et  seq. 

day  terrors,  243 

diet,  246,  247 

enuresis,  244,  245 

hours  of  work,  250 

hygiene  of  nursery,  245,  et  seq, 

mental  hygiene,  247,  et  seq. 

morbid  fears,  241,  242 

night  terrors,  242,  243 

physical  exercise,  251 

signs    of   nervous   temperament, 
240,  241,  242 

sleep,  250,  251 

suggested  routine,  251,  252 
China,  46 
Clergymen,  65 
Climate,  60,  65 

Africa,  66,  67 

India,  66 
Clothes,  218,  219 
Clouston,  Sir  Thomas,  M.D.,  58 

on  adolescence,  257 

on  inherited  nerve  weakness,  68 
Coffe,  72,  73 
Colon,  71 
CoUtis,  134 
Common  cold,  as  a  cause  of  nervous 

breakdown,  74 
Conflict,  mental,  33,  34 
Confusion,  14,  92 
Consanguinity,  68,  69,  70 
Conscience,  55 

morbid,  56 

nerves  and,  55 
Consciousness,  20 
Constipation,  132,  133 
Constitution,  6 


Control,  14 

mental,  14,  260,  et  seq. 
Convalescence,  209,  et  seq. 
Convulsions,  hysterical,  147,  150 
Cowper,  47 

Cromwell,  OUver,  40,  44 
Crucifixion  attitude,  147 
Cycling,  235 


D 


Daniel  Defoe,  42 
D'Artagnan,  44 

Davis,  Mr.  Arthur  N.,  on  the  ex- 
Kaiser,  60 
Day  terrors,  243 
Deafness,  280,  283 
Dejerine,  Prof.  J.,  18 
Depression,  10,  12,  35,  56,  76,  92, 
101-  105,  284,  295 

influenza,  74 
Demoniacal    possession,    alleged, 

and  hysteria,  160 
Dickens,  Chas.,  44 
Diet,  136,  209,  et  seq. 

alcohol.  214,  215 

cheese,    14, 

effective  constituents,  210 

fads,  211 

fish,  210 

idiosyncrasies,  211 

in  childhood,  246,  247 

milk,  212 

phosphorus,  200 
Dignity,  21 

Disappointment,  24,  37,  51 
Disease — 

abscesses,  75 

boils,  75 

chronic  infection,  75 

common  cold,  74 

carbuncles,  75 

functional,  184,  185 

general,  and  nervous  breakdown, 
60,74 

infiuenza,  74 

common  cold,  74 

organic,  184,  185 

pyorrhoea  (Rigg's  disease)  75 

syphilis,  75 

trench  fever,  74 

typhoid  fever,  74 

tuberculosis,  75 
Dissociation,  168 
Doctors,  and  nervous  breakdown,  60 


INDEX 


293 


Domestic    servants,    and    nervous 

breakdown,  62 
Domestic  worry,  35,  36,  37 

difficulties,  56,  57 
Doubts — 

about  fire,  117 

about  promises,  118 

conscientious,  116 

nervous,  3,  116,  et  seq. 

religion,  116 
Dreams,  in  sbell-shock,  284,  286 
Drugs  in  nervous  breakdown,   175 
Drug  taking,  73 
Dubois,  Prof.,  25 

on  indigestion,  127 

on  the  emotions,  25 
Dumbness,  280,  282 
Dyspepsia,  124 

E 

Eccentricity,  46 
Ecstatic  pose,  147 
Efficiency — 

and  nervous  discord,  4 

and  nerve  health,  4 

nerve  and,  3 

of  a  nation,  3 
Egocentricity,  49 
Egoism,  morbid,  49 
Electricity,  178,  179,  180,  245 
Emotion,  6,  7,  17,  et  seq. 

and  body  reaction,  20,  et  seq. 

and  intellect,  27 

and  nervous  breakdown,  17 

emotional  storms,  51 

example  of  emotional  stress  in- 
fluencing breakdown,  35,  36,  37 

intensity  of,  32 

memory  of,  32 

repression  of,  32 
Enuresis,  244,  245 
Environment,  39,  40 

misfits — "  martial  "    and    others, 
40 
Envy,  55 

Essays  of  Elia,  242 
Eugenics,  and  nervous  breakdown, 

15,  16,  17 
Explosives,  269,  et  seq. 

F 

Faith,    and   foundation    of   mental 
health,  182,  265 
and  recovery,  186 


Fatigue,  7,  12   90,  93,  99,  102,  148, 
151 

"  brain  fag  "  92 

and  war,  269 
Fear,  1,  3,  22,  23,  264 

of  animals,  14,  115 

of  cats,  15 

of  closed  spaces,  111 

of  colours,  14 

of  darkness,  14 

of  disease,  114,  120 

of  everything,  101 

of  harming  people,  120 

of  high  places,  115 

of  illness,  115 

of  impulsive  action,  120 

of  insanity,  95,  120 

of  lifts,  13 

of  mice,  15 

of  miscellaneous  things,  115 

of  open  spaces,  13,  111 

of  people,  113,  120 

of  railway  journeys,  112 

of  sudden  death,  164 

of  sudden  iLkiess,  120 

of  things  falling,  115 

of  thunderstorms,  14,  114 

of  travelling  alone,  120 

of  underground  railways,  13 

and  war-strain,  272,  et  seq. 
Fears,  13,  14 

agoraphobia,  111 

astrophobia,  114 

batophobia,  114 

claustrophobia.  111 

morbid,  197,  et  seq. 

pathophobia,  114 
Felida  X,  156 
Fever,  145 
Flapper,  255,  256 
Flatulence,  131,  148 
Francis  Drake,  44 
Freud,  Prof.,  and  hysteria,  169 
Fright,  22 
Functional,  the  term,  184 


G 

Gambling,  53 

"  Gastric  neurasthenia  "124 

Gastroptosis,  134 

Gauclder,  Dr.  E.,  18 

Giddiness,  13,  35,  72,  99,  238,  284 

in  neurasthenia,  89 
Gladstone,  and  sleep,  223 


294  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 


Golf,  236 

Goodhart,     Sir    James,     M.D.,   on 

nervous  indigestion,  129 
Goose-flesh,  23 
Grief,  20,  23,  24 


H 


Hamilton,  Dr.  McLane,  50 
Harmony  in  the  human  system,  81 
Hate,  51,  55 
Head,  13 

noises  in,  13 
Headache,  12,  36,  91,  133,  151,  284 
Head-wounds,  272 
Heart,  in  neurasthenia,  97,  98,  102, 

104 
Henry  VIII,  66 
Heredity,  6,  60,  67,  et  seq. 
HerscheU,  George,  M.D„  on  nervous 

dyspepsia,  127 
Hippocrates,  42 
Hygiene — 

errors  of,  7 

nerve,  172,  et  seq. 
Hygiene  of  Mind  by   Sir  Thomas 

Clouston,  M.D.,  quoted  68 
Hypersensitiveness  in  neurasthenia, 

98 
Hypersesthesia,  144 
Hypnotism,  161,  183,  187 
Hysteria,  85,  138,  et  seqi 

anaBsthesia,  143,  144,  150 

and  age,  78 

aphonia,  142,  150,  152 

attacks  of,  145,  et  seq. 

automatism,  148 

automatic  writing,  161 

catalepsy,  151 

Charcot,  146 

crucifixion  attitude,  147,  150 

day  dreams  of  the  hysteric,  144, 
145 

ecstatic  pose,  147 

factors  leading  up  to,  141 

fever,  145 

general  signs,  140 

hemiplegia,  141 

hypersesthesia,  144,  149 

hysterical  temperament,  1 62,et  seq. 

illustrative  notes,  148 

imitative  phenomena,  145,  152 

la  grande  hysterie,  146 

living  skeleton,  145 

monoplegia,  141 


Hysteria — 
multiple  personaUty,  151 
neuralgia,  144 
paralysis,  141 
paraplegia,  141,  150 
spasmodic  phenomena,  143,  147, 

150 
Sydenham,  description  of,  139 
theories  of,  166,  et  seq. 
witch's  marks,  143 


Impulses,  11,  110 

Indecision,  15 

India,  6,  46,  66 

Indigestion,  35,  72,  et  seq.,  124,  148, 

151 
Individual,  reaction,  27 
Influenza,  74 

and  neurasthenia,  74,  105 
Inhibition,  14,  262,  263 
Insanity,  85 

and  alcohol,  73 
Intermarriage,  68,  69,  70 
Intellect,  26 

and  emotion,  27 
Irritable  weakness,  90 
Ivan  the  Terrible,  44 


James,  Wm.,  25,  157 

on  the  emotions,  25 

on  faith,  265 

on  the  "sick  soul,"  181 
Janet,  Prof.  P.,  159,  167,  168 
Jealousy,  21,  51,  58 
Jews,  77 
John  Gilpin,  47 
JournaUsts,  and  nervous  breakdown, 

60 
Juhus  Caesar,  44 

K 

King  Harold,  44 
KipUng,  Mr.  Rudyard,  67 

description  of  nervous  breakdown 
noted,  67 
Knights  of  the  Round  Table,  44 


La  grande  hysterie,  146 
Labourers  and  nervous  breakdown, 
62 


INDEX 


296 


Lamb,  Charles,  on  children's  fears, 

242,  243 
Lamp-post,  obsession  about,  14 
Lancet,  The,  130 
Living  skeleton,  146 

M 
Malaria,    as    a    cause    of    nervous 

breakdown,  74 
Malice,  55 
Man,  14 

pre-eminence  of,  14 
Manual  workers,  and  nervous 

breakdown,  63 
Mantegazza  on  anger,  21 
Mark  Tapley,  45 
Mary  Tudor,  24 
Massage,  178,  181,  204,  205 
Megalomania,  49 
Memory,  loss  of,  76,  92,  155 
Memories  and  Portraits,  by  R.   L. 

Stevenson,  85,  96 
Mental  Control,  7,  14 

loss  of,  14 

importance  of,  94 
Mental — 

the  term,  86 

dissociation,  168 

confusion,  92 
Micawber,  Mr.,  46 
Midsummer  Nights  Dream,  23 
Mind,  7,  82 

certain  qualities  of,  9 
Mind  cure,  183,  185 
MitcheU,  Dr.  Weir,  189,  190 
Moliere,  189 
Monoplegia,  141 
Morbid,  14 

conscience,  56 

egoism,  49 

emotional  response,  33 

fear,  14,  107,  et  seq. 

flushing,  14,  114. 

thoughts,  77 
Morphia,  73 

Motoring,and  nervous  breakdown,63 
Multiple  personahty,  163,  et  seq. 

and  alleged  "  possession,"  160 

Dr.  Morton  Prince's  investigation, 
158 

FeHda  X, 166 

Leonie,  169 

Prof.  Janet's  investigation,  159 

Rev.  A.  B.,  157 

Sally  Beauchamp,  158 


N 
Napoleon,  40 

on  sleep,  223 
Navvies,  and  nervous  breakdown,  62 
Negroes,  and  nervous  breakdown,  77 
Nelson,  44 

Nerve,  and  efficiency,  3 
Nerve-energy,  59 
Nerve-cells,  7 

and  alcohol,  73 
Nerve-centres,  7,  82 

fatigue  of,  90 
Nerve-fibres,  7 

and  alcohol,  73 
Nerve-force,  15 

of  nation,  15 
Nerve-tonic,  176 
Nerve-poisons,  60,  71,  et  seq. 

influenza,  74 

morphia,  73 

tea,  72 

typhoid  fever,  74 
Nerves — 

and  family  life,  56 

a  popular  term,  83 

sensitive,  56 
Nervous — 

dyspepsia,  124,  et  seq. 

fears,  14 

indigestion,  124,  et  seq. 
Nervous  attacks,  9,  101,  260 
Nervous  children,  12 

character  building,  39 
Nervous  indigestion, 

attacks  of,  132 

characteristics  of,  130,  et  seq. 
Nervous  system — 

and  control,  82 

and  general  disease,  74 

and  high  explosives,  271 

and  influenza,  74 

and  tjrphoid  fever,  74 

development  of,  82 

exhaustion  of,  95 

functions  of,  82 

How  subject  to  stress,  6,  59 

inherited  weakness,  67,  68,  69 
Nervous  tissues — 

hardiness  of,  8,  9 

irritabihty,  67 

seaside,  236 

sea  voyages,  237 

seK-help,  258,  et  seq. 

sleep,  220,  et  seq. 

siderophobia,  112 


296  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 


Nervous  tissues- 
smoking,  237,  238,  239 

some  theories,  7 

Turks,  77 

types  of,  83 

ubiquitous  occurrence,  4 

United  States,  77 

vicious  circle,  129 

war-strain,  269,  et  seq. 
Nestor,  21 
Neuralgia,  13,  35,  101,  144,  148,  151, 

238 
Nervous  breakdown,  1,  14,  19,  50 

agoraphobia.  111 

alcohol,  214,  215 

American  negro,  77 

and  ancestry,  67,  68 

and  accidents,  75,  76 

and  intermarriage,  69 

and  the  "  Good  Old  Days/'  67 

and  the  emotions,  19,  30 

and  temperament,  42,  45 

anthropophobia.  111 

astrophobia,  113 

auto-intoxication,  71,  128 

batophobia,  114 

baths,  21,  57,  216,  217 

causes,  60,  78 

childhood,  240,  et  seq. 

classification,  84,  et  seq 

claustrophobia.  111 

climate,  65 

clothes,  218,  219 

diet,  209,  et  seq. 

disturbed  taste,  130 

electricity,  178,  179,  180 

exercise,  219 

faith,  and  mental  health,  182 

house  of  Wittelsbach,  69 

hysteria,  85,  138,  et  seq. 

impulses,  110 

in  America,  65 

in  India,  66,  67 

in  prof  essional  men,  15,16,60,61,65 

indigestion,  124 

Jews,  77 

massage,  178,  179,  180 

mind  cure,  183 

morbid  doubts,  13,  116,  et  seq. 

Mr.   Rudyard  Kipling's   descrip- 
tion of,  67 

nuerasthenic  state,  89,  et  seq. 

neurasthenia.    See  rcf. 

obsessing  phrases,  123 

obsessions,  107,  et  seq. 


Nervous  breakdown — 

occupation,  6,  15,  16,  60,  et  seq. 
pathophobia,  114 
persuasion,  183 
phobias,  110 
physical  causes,  8 
physical  remedies,  178 
psychasthenia,  107,  108 
racial  response,  77 
recreations,  235,  236,  237 
rest  cure,  188.  et  seq. 
Neurasthenia,  18,  19,  45,  85 
abscesses,  75 
amongst  students,  59 
and  alcohol,  73 
and  influenza,  74 
and  malaria,  74 
and  particular  ages,  78 
and  trench  fever,  74 
and  tropics,  66,  67 
and  typhoid  fever,  74 
and  wrong  thoughts,  55 
"  attacks,"  101 
boils,  75 

breathlessness,  97 
carbuncles,  75 

detailed  description  of,  89,  et  seq. 
disturbed  sleep,  90,  93,  94,  100, 

101,  105,  223,  et  seq. 
examples  of,  99,  et  seq. 
examples  of — associated  with  em- 

tional  disturbance,  35,  36,  37 
fatigue,  90,  99,  93,  102 
fear,  264 
gastric,  124 
general  health  disturbance  in,  96, 

et  seq. 
giddiness,  98,  99 
heart,  97,  98,  102,  104 
hypersensitiveness,  98 
illustrative  notes,  93 
indigestion,  99,  et  seq. 
in  old  age,  78 
irritabihty,  102 
morbid  fears,  95,  101 
neuralgia,  101 
obsessional,  108 
of  war,  278 

operations  as  a  cause  of,  77 
palpitation,  97,  100 
pyorrhoea  (Rigg's  disease),  75 
racial  response,  77 
sensation,  91,  et  seq. 
sex  questions,  99 
special  mental  symptom8,93,  et  seq. 


INDEX 


297 


Neurasthenia — 

sjrphilis,  75 

the  term,  87 

traumatic,  76 

tuberculosis,  75 

typical  headache,  91 

typical  story  of,  90 

visional  troubles,  36 
Neuritis,  73 
Night  terrors,  242,  243 
Nissl's  granules,  176 
Noises  in  head,  13 
Northern  Europe,  tribes  of,  46 
Nursing,  195,  196,  197 

0 

Obsessional  neurasthenia,  108 
Obsessions,  197,  et  seq. 
Octogenarian,   and  nervous  break 

down,  77 
Octogenarian,  story  of,  136 
Occupations,   and    nervous    break- 
down, 6,  60,  et  seq. 

actors,  65 

business  promotors,  65 

clerifymen,  65 

dangers  of  lack,  61 

in  America,  65 

motoring,  63 

railway  workers,  64 

speculators,  65 

telephone  workers,  64 

the  professions,  15,  16,  60,  61,  65 
Operations,  and  nervous  breakdown, 

77 
Organic,  the  term,  184 
Osier,  Prof.  W.,  System  of  Medicine, 

quoted,  35,  77,  170 
Over-emotionalism,  141 

P 

Pain,  76,  101 
Palpitation,  72,  100 
Paraplegia,  141 
Paralysis,  141,  150 
Pare,  Ambroise,  189 
Pascal,  27 

on  the  emotions,  27 
Pathophobia,  114 
Pecksniff,  Mr.,  45 
Personality — 

alternating,  156 

Fehda  X,  156 

Leonie,  159 

Rev.  A.  B.,  156 

Sally  Beauchamp,  158 


Persuasion,  183 
Phobias,  110 
Phosphorus,  216 
Phrases — 

obsessing,  103 
Pickwick  Mr.,  45 
Pithiatism,  138 
Pliny,  136 
Poisoning,  7,  8,  71,  et  seq. 

abscesses,  75 

auto-intoxication,  71 

boils,  75 

chronic  infection,  75 

carbuncles,  75 

from  stomach,  bowel  and  colon,  71 

influenza,  74 

morphia,  73 

of  nervous  system,  60 

pyorrhoea  (Rigg's  disease),  75 

syphilis,  75 

tea,  72 

tobacco,  238,  239 

tuberculosis,  75 

typhoid  fever,  74 
Pressure  headache,  91 
Pride,  21 

Prince,  Dr.  Morton,  158 
Prince,  Hal,  44 

Prosperity,  and  damaged  brain,  11 
Psalm  scix,  23 
Psychasthenia,  85,  107,  108 

the  term,  87 
Psychoanalysis,  169,  183,  187 
Psychoneurosis — 

the  term,  86,  87 

and  the  war,  270,  281 
Psychoneurosis  of  war,  281 
Psychological  causes,  18 

Dejerine  and  Gauckler,  18 

Babinski,  19 

SaviU,  19 

physical,  19 
Puberty,  59 
Punjaub  Head,  67 
Pyorrhoea  alveoraUs  (Rigg's  disease), 

75 

Rage,  22  ^ 

Railway     workers,     and     nervous 

breakdown,  64 
Reaction,  individual,  27 
Recreations,  230,  et  seq. 

cycling,  235 

golf,  236 

hobbies,  235,  236 

walking,  235 


298  THE  PROBLEM  OF  NERVOUS  BREAKDOWN 


Redressing  the  balance,  173,  et    eg. 

Remorse,  55 

Resj)onse,  emotional,  17,  et  seq, 

excessive,  33 

individual,  31,  33 

morbid,  33 
Rest,  7,  188,  et  seq,  230,  et  seq, 

in  nervous  dyspepsia,  136 

rest  hour,  230 

seaside,  236 
Rest  cure,  187,  et  seq. 

attitude  of  invalid,  192 

daily  programme,  208 

daily  routine,  201 

duration,  192 

exercise,  204 

friends,  199 

general  surroundings,  198 

massage,  204,  205 

mental  occupation,  202 

nourishment,  203,  204 

nursing,  195,  196,  197 

place,  193,  194,  199 

principles  of,  191 

relatives,  194,  199 

sleep,  202,  203 

tasks,  206,  207 

Weir  MitcheH,  189,  1^90 
Retirement,and  nervous  breakdown. 

61,  62 
Ribot,  Prof.,  42 
Richard  Coeur  de  Lion,  44 
Richard  III,  44 
Rigg's  disease,  75 
Rigg's  disease  (pyorrhoea),  75 
Romans  xiii.  12,  265 
Roussy  and  Lhermitte,  281 

8 
Sally  Beauchamp,  158 
Sanatoria,  for  nervous  breakdown,15 
Savill,  the  late  Dr.  T.  D.,  19,  128 
Scott,  Sir  Walter,  47 
Schumann,  48 
Schubert,  48 
Scruples,  110 
Self-confidence,  want  of,  13 

in  shell-shock,  289 
Self-control.    (S'ee  Control 
Self-denial,  263 
Self-help,  258,  et  seq. 
Self-knowledge,  261 
Self-reverence,  261 
Sensation — 

neurasthenic,  27,  91,  et  seq. 

head,  92 


Sex  theory,  58,  168 

Shakespeare,  Wm.,  quotationa,  21, 

23,  44,  91,  119,  184 
Shaw,  Dr.  T.  Claye,  46 
SheUey,  47 
SheU-shock,  270,  et  seq. 

astasia-abasia,  281 

dreams,  284,  286 

examples  of,  284,  et  seq. 

general  features,  280 

head-wounds,  272  _ 

mental  confusion,  280 

mental  symptoms,  286,  et  seq. 

paralysis,  280,  284,  et  seq. 

problem  of,  287,  et  seq. 

special  senses,  280,  282 

the  outlook,  290 

unconsciousness,  280 
Sheridan,  47 
Shock — 

from  accidents,  75 

shell-shock,  76 
"Shooting  pains,"  92 
Shyness,  14 
Siderophobia,  112 
Sleep,  220,  et  seq. 

Bacon,  221 

disturbed,  72,  76,  90,  93,  100, 
101,  105,  133,  151,  220,  et  seq, 
284 

induction  of,  227,  228 

maxims,  228,  229 

morbid  fears,  226 

personal  idiosyncrasies,,  223 

recuperative  powers   of,   8,    221, 
222 
Slough  of  despond,  33 
Soldier's  heart,  274 
Sorrow,  23 
Southey,  221 
Speculators,  65 
Stevenson,  R.  L.,  253,  261 

description  of  nervous  breakdown; 
95,  96 
St.  Vitus'  dance,  143 
Stomach,  71 

atony  of,  132,  134 
Subconsciousness,  26 
Suggestion,   11,  26,   144,   149,   161, 
160,   167,   177,   183,   187,   245, 
288 
Suggestibihty — 

abnormal,  141,  162 

in  adolescence,  255 
Sulkiness,  57 
Sydenham  on  hysteria,  139 


INDEX 


299 


Taste,  disturbed,  130 
Tea,  72 

China,  72 
Teeth- 
decayed,  75 

pyorrhoea  (Rigg's  disease),  75 
Telephone    workers,    and    nervous 

breakdown,  64,  65 
TeU,  Wm.,  30 
Temper,  bad,  57 
Temperament,  6,  38 

and  aviation,  41 

and  genius,  47 

apathetic,42 

bilious,  42 

blends  of,  42,  45 

differences  of,  41 

phlegmatic,  41 

hysterical,  162,  et  seq. 

melancholic,  42 

nervous,  38,  et  seq.,  84,  182,  et  seq. 

sanguine,  41 

sensitive,  42 

temperate,  42 
Tennyson,  261 
Theine,  72 
Theories  of  nervous  breakdown,  18, 

19 
Thought  processes,  17 
Thoughts,  11 

impulsive,  11 

racing,  13 

obsessing,  13,  106,  et  seq. 

morbid — in  old  age,  77 

sense  of  loss  of  control,  92,  94 
Three  Musketeers,  44 
Tiredness,  12 

Tobacco,  72,  237,  238,  239 
Tone,  125 
Tongue — 

nervous  furring,  129 
Traumatic  neurasthenia,  76 

shell  shock,  76 
Treatment,  173,  et  seq. 
recreation,  235,  236,  237 

sea  voyage,  237 

seaside,  236 
self-help,  258 
smoking,  237,  238,  239 
Trembling,  72,  76,  143 


Trench  fever,  as  a  cause  of  nervous 

breakdown,  74 
Troilus  and  Cressida,  21 
Turks,  77 
Typhoid  fever,  as  a  cause  of  nervous 

breakdown,  74 


U 


United  States,  35,  77 
Uriah  Heep,  45 


Vicious  circle,  129 

Victorian  era,  67 

Vision,  disturbances  of,  36 

W 
Wagner,  48 
Walking,  219,  235 
War,  and  air-raids,  276 

and  civilians,  274 

and  nervous  disease,  5,  141 

breakdowns  of,  69,  et  seq. 

characteristics  of,  278 

strain  of,  269,  et  seq. 
Webster,  definitions,  20,  109,  125 
wm,  34 

William  II,  ex-Kaiser,  48,  50 
William  of  Orange,  44 
Witch-hunting,  140 
Witch's  marks,  143,  149 
Wolsey,  Cardinal,  44 
Wordsworth,  47 

Workers,  and  nervous  breakdown- 
artisans,  64 

brain,  60,  61 

chauffeurs,  64 

labourers,  64 

manual,  62 

porters,  64 

railway,  64 

telephone,  64 
Worry,  10,  18,  19,  35,  36,  51,  et  seq. 

and  faith,  264 

and  imaginary  troubles,  54 

domestic,  35,  36,  37 


X-ra.ys — 

and  nervous  indigestion,  134,  145 


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WILLIAM    BRENDON   AND   SON,    LTD. 

PLYMOUTH     ENGLAND 


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